Provider Demographics
NPI:1508243171
Name:MAYER, ATALIE (AP)
Entity Type:Individual
Prefix:
First Name:ATALIE
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4061
Mailing Address - Country:US
Mailing Address - Phone:321-345-8228
Mailing Address - Fax:321-574-6788
Practice Address - Street 1:134 5TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3133
Practice Address - Country:US
Practice Address - Phone:321-345-8228
Practice Address - Fax:321-574-6788
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01564171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist