Provider Demographics
NPI:1255949087
Name:AUDEVERT, CARMEN NATALYA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:NATALYA
Last Name:AUDEVERT
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 1:6044 BENT PINE DR APT 3324
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-6823
Mailing Address - Country:US
Mailing Address - Phone:786-337-3780
Mailing Address - Fax:
Practice Address - Street 1:6250 HAZELTINE NATIONAL DR STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5102
Practice Address - Country:US
Practice Address - Phone:407-237-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician