Provider Demographics
NPI:1619125622
Name:DOMNITZ-GEBET, AVI ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:AVI
Middle Name:ELIZABETH
Last Name:DOMNITZ-GEBET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4107 NEPTUNE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6741
Mailing Address - Country:US
Mailing Address - Phone:321-805-4398
Mailing Address - Fax:
Practice Address - Street 1:4107 NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6741
Practice Address - Country:US
Practice Address - Phone:321-805-4398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS156542084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology