Provider Demographics
NPI:1891253357
Name:ATLANOV, ALEKSEY (AP)
Entity Type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:ATLANOV
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SEA GRAPE TER
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2126
Mailing Address - Country:US
Mailing Address - Phone:386-216-7191
Mailing Address - Fax:
Practice Address - Street 1:7 SEA GRAPE TER
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-2126
Practice Address - Country:US
Practice Address - Phone:386-216-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2846171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty