Provider Demographics
NPI:1376944884
Name:ACQUAVIVA, ANTHONY EDWARD (VMD, DACVS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:ACQUAVIVA
Suffix:
Gender:M
Credentials:VMD, DACVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4621
Mailing Address - Country:US
Mailing Address - Phone:203-929-8600
Mailing Address - Fax:
Practice Address - Street 1:895 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4621
Practice Address - Country:US
Practice Address - Phone:203-929-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3602174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian