Provider Demographics
NPI:1922593102
Name:LE MONTE, TYSON (DOM, AP)
Entity Type:Individual
Prefix:DR
First Name:TYSON
Middle Name:
Last Name:LE MONTE
Suffix:
Gender:M
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 74TH PL E
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-4010
Mailing Address - Country:US
Mailing Address - Phone:941-376-5492
Mailing Address - Fax:
Practice Address - Street 1:4655 47TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-3606
Practice Address - Country:US
Practice Address - Phone:941-376-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3953171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist