Provider Demographics
NPI:1700513611
Name:MANOUSELIS, AVGERO
Entity Type:Individual
Prefix:
First Name:AVGERO
Middle Name:
Last Name:MANOUSELIS
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 1:24387 LEBERN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1040
Mailing Address - Country:US
Mailing Address - Phone:440-281-5007
Mailing Address - Fax:
Practice Address - Street 1:29201 AURORA RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1846
Practice Address - Country:US
Practice Address - Phone:440-281-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist