Provider Demographics
NPI:1477013829
Name:SAPORITO, AVERY NICOLE (MD)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:NICOLE
Last Name:SAPORITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 N CENTRAL EXPY STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-6009
Mailing Address - Country:US
Mailing Address - Phone:214-820-9272
Mailing Address - Fax:
Practice Address - Street 1:9101 N CENTRAL EXPY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6009
Practice Address - Country:US
Practice Address - Phone:214-820-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU55072084P2900X, 2084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program