Provider Demographics
NPI:1467947069
Name:VICTORIA, AYDEE
Entity Type:Individual
Prefix:
First Name:AYDEE
Middle Name:
Last Name:VICTORIA
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 1:999 SW SHILOH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WHITE
Mailing Address - State:FL
Mailing Address - Zip Code:32038-2829
Mailing Address - Country:US
Mailing Address - Phone:352-262-9147
Mailing Address - Fax:
Practice Address - Street 1:13795 SW 36TH AVENUE RD STE 1
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-6104
Practice Address - Country:US
Practice Address - Phone:352-533-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator