Provider Demographics
NPI:1134480999
Name:TOMAO-AQUAVIVA, HEIDY
Entity Type:Individual
Prefix:MRS
First Name:HEIDY
Middle Name:
Last Name:TOMAO-AQUAVIVA
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 1:20218 45TH DR
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3056
Mailing Address - Country:US
Mailing Address - Phone:516-385-9784
Mailing Address - Fax:
Practice Address - Street 1:20218 45TH DR
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3056
Practice Address - Country:US
Practice Address - Phone:516-385-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY836893174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist