1578954525 NPI number — NANDY AUGUSTIN ISW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578954525 NPI number — NANDY AUGUSTIN ISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUGUSTIN
Provider First Name:
NANDY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ISW
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:
1578954525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14041 ICOT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33760-3702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-450-7269
Provider Business Mailing Address Fax Number:
727-479-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 NE 40TH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33334-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-703-3570
Provider Business Practice Location Address Fax Number:
354-703-3571
Provider Enumeration Date:
02/12/2015

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: 104100000X , with the licence number:  ISW 8570 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ISW 8570 . This is a "DEPARTMENT OF HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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