Provider Demographics
NPI:1073098661
Name:ANDERSON, ELIANA PIVA
Entity Type:Individual
Prefix:
First Name:ELIANA
Middle Name:PIVA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10368 NW 24TH PL APT 405
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-7016
Mailing Address - Country:US
Mailing Address - Phone:954-556-0536
Mailing Address - Fax:
Practice Address - Street 1:10368 NW 24TH PL APT 405
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-7016
Practice Address - Country:US
Practice Address - Phone:954-556-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty