Provider Demographics
NPI:1144568627
Name:HOSPEDALES, AVIANNE (MD)
Entity Type:Individual
Prefix:
First Name:AVIANNE
Middle Name:
Last Name:HOSPEDALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:561-270-6950
Mailing Address - Fax:561-404-4028
Practice Address - Street 1:5848 WEST ATLANTIC AVE SUITE 143
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-270-6950
Practice Address - Fax:561-404-4028
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122120207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine