Provider Demographics
NPI:1215013347
Name:AVIGLIANO, IMELIZA FERNANDEZ (MS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:IMELIZA
Middle Name:FERNANDEZ
Last Name:AVIGLIANO
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MS
Other - First Name:IMELIZA
Other - Middle Name:MIRADOR
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PA-C
Mailing Address - Street 1:5936 LIMESTONE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8930
Mailing Address - Country:US
Mailing Address - Phone:302-239-4500
Mailing Address - Fax:302-489-5000
Practice Address - Street 1:5936 LIMESTONE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8930
Practice Address - Country:US
Practice Address - Phone:302-239-4500
Practice Address - Fax:302-489-5000
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine