Provider Demographics
NPI:1225689284
Name:AUGUSTE, MARIE MICKAELLE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MICKAELLE
Last Name:AUGUSTE
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 1:1421 MAGELLAN CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-6733
Mailing Address - Country:US
Mailing Address - Phone:321-262-4447
Mailing Address - Fax:
Practice Address - Street 1:1421 MAGELLAN CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6733
Practice Address - Country:US
Practice Address - Phone:321-262-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities