Provider Demographics
NPI:1689169120
Name:KOROMILAS, ALICIA KAYE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KAYE
Last Name:KOROMILAS
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 1:3887 GOLDEN MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9207
Mailing Address - Country:US
Mailing Address - Phone:407-542-4744
Mailing Address - Fax:
Practice Address - Street 1:3887 GOLDEN MEADOW CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9207
Practice Address - Country:US
Practice Address - Phone:407-542-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer