Provider Demographics
NPI:1629581145
Name:ISIDORE, MARLYE
Entity Type:Individual
Prefix:
First Name:MARLYE
Middle Name:
Last Name:ISIDORE
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 1:37707 AARALYN RD APT 80
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-3223
Mailing Address - Country:US
Mailing Address - Phone:813-455-7904
Mailing Address - Fax:
Practice Address - Street 1:37707 AARALYN RD APT 80
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3223
Practice Address - Country:US
Practice Address - Phone:813-455-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician