Provider Demographics
NPI:1427394790
Name:AVERSANO, EDUARDO THEODORE (ACUPINCTURIST)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:THEODORE
Last Name:AVERSANO
Suffix:
Gender:M
Credentials:ACUPINCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 W PALMETTO PARK RD
Mailing Address - Street 2:STE 103C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3455
Mailing Address - Country:US
Mailing Address - Phone:561-395-2667
Mailing Address - Fax:561-395-2685
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:STE 103C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3455
Practice Address - Country:US
Practice Address - Phone:561-395-2667
Practice Address - Fax:561-395-2685
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000366-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist