1184928202 NPI number — MRS. ALLYSON RAE VILLAFANE M.A

Table of content: MRS. ALLYSON RAE VILLAFANE M.A (NPI 1184928202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184928202 NPI number — MRS. ALLYSON RAE VILLAFANE M.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLAFANE
Provider First Name:
ALLYSON
Provider Middle Name:
RAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A
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:
1184928202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 LAKESHORE DRIVE
Provider Second Line Business Mailing Address:
APT 311
Provider Business Mailing Address City Name:
LAKE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-655-5362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 LAKESHORE DR
Provider Second Line Business Practice Location Address:
APT 311
Provider Business Practice Location Address City Name:
LAKE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33403-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-655-5362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2011

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8250 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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