Provider Demographics
NPI:1588816805
Name:PICCIANO, DEANINE LYNN (AP LMT)
Entity Type:Individual
Prefix:
First Name:DEANINE
Middle Name:LYNN
Last Name:PICCIANO
Suffix:
Gender:F
Credentials:AP LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15805
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-1805
Mailing Address - Country:US
Mailing Address - Phone:941-726-2345
Mailing Address - Fax:
Practice Address - Street 1:1435 S OSPREY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2905
Practice Address - Country:US
Practice Address - Phone:941-726-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP900171100000X
FLMA18930225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7562OtherBCBS
FLC4315OtherBC/BS