Provider Demographics
NPI:1235597410
Name:AVISHAR, NANCY
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:AVISHAR
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 1:3829 EASTON ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2612
Mailing Address - Country:US
Mailing Address - Phone:941-228-7789
Mailing Address - Fax:
Practice Address - Street 1:3829 EASTON ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2612
Practice Address - Country:US
Practice Address - Phone:941-228-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA79950225700000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist