Provider Demographics
NPI:1467046722
Name:BARROSO ARAGAO MADRUGA CAVALCANTI, LIA
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:BARROSO ARAGAO MADRUGA CAVALCANTI
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 1:8303 DEERBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4385
Mailing Address - Country:US
Mailing Address - Phone:786-554-9480
Mailing Address - Fax:
Practice Address - Street 1:6320 15TH ST E STE C4
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-3263
Practice Address - Country:US
Practice Address - Phone:941-751-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001231223G0001X
NY390200000X
FLDN26258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program