Provider Demographics
NPI:1083126296
Name:PANARO, NASTASSIA DOMINIQUE
Entity Type:Individual
Prefix:
First Name:NASTASSIA
Middle Name:DOMINIQUE
Last Name:PANARO
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 1:1617 FORT SMITH BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-4805
Mailing Address - Country:US
Mailing Address - Phone:407-223-5889
Mailing Address - Fax:
Practice Address - Street 1:1617 FORT SMITH BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-4805
Practice Address - Country:US
Practice Address - Phone:407-223-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician