Provider Demographics
NPI:1336817352
Name:NGUYEN, THAO-VY
Entity Type:Individual
Prefix:
First Name:THAO-VY
Middle Name:
Last Name:NGUYEN
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 1:1410 COOPERS HAWK WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8790
Mailing Address - Country:US
Mailing Address - Phone:630-631-6453
Mailing Address - Fax:
Practice Address - Street 1:1831 GOLDEN EAGLE WAY STE 34
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4340
Practice Address - Country:US
Practice Address - Phone:904-579-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician