Provider Demographics
NPI:1184901415
Name:FIORAVANTI, PAUL (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FIORAVANTI
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 HARBOUR VIEW BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3760
Mailing Address - Country:US
Mailing Address - Phone:757-539-3911
Mailing Address - Fax:757-925-0615
Practice Address - Street 1:5833 HARBOUR VIEW BLVD STE C
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3760
Practice Address - Country:US
Practice Address - Phone:757-539-3911
Practice Address - Fax:757-925-0615
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000620171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist