Provider Demographics
NPI:1831666924
Name:NUSINER DESIDERI, ELISA
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:NUSINER DESIDERI
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 1:2286 SW 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5527
Mailing Address - Country:US
Mailing Address - Phone:305-680-4061
Mailing Address - Fax:
Practice Address - Street 1:2286 SW 81ST AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5527
Practice Address - Country:US
Practice Address - Phone:305-680-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty