Provider Demographics
NPI:1851797658
Name:RUSNAK, CECILIA
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:
Last Name:RUSNAK
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 1:1107 PERSON ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4146
Mailing Address - Country:US
Mailing Address - Phone:407-624-5258
Mailing Address - Fax:407-289-4047
Practice Address - Street 1:1107 PERSON ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4146
Practice Address - Country:US
Practice Address - Phone:407-624-5258
Practice Address - Fax:407-289-4047
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3582171100000X
FL48-44-2692456246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other