1760937155 NPI number — ASZLOYN NIKITA WAKEFIELD ED.S.

Table of content: ASZLOYN NIKITA WAKEFIELD ED.S. (NPI 1760937155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760937155 NPI number — ASZLOYN NIKITA WAKEFIELD ED.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAKEFIELD
Provider First Name:
ASZLOYN
Provider Middle Name:
NIKITA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ED.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760937155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12280 SUMTER SQUARE DR W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32218-6125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-622-8684
Provider Business Mailing Address Fax Number:
904-765-0011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12280 SUMTER SQUARE DR W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32218-6125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-622-8684
Provider Business Practice Location Address Fax Number:
904-765-0011
Provider Enumeration Date:
08/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com