Provider Demographics
NPI:1679985444
Name:NYAWARA, PERMINUS
Entity Type:Individual
Prefix:MR
First Name:PERMINUS
Middle Name:
Last Name:NYAWARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MT. DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757
Mailing Address - Country:US
Mailing Address - Phone:352-383-0051
Mailing Address - Fax:
Practice Address - Street 1:300 BROOKSVILLE AVENUE
Practice Address - Street 2:
Practice Address - City:MT. DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-383-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5673225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist