Provider Demographics
NPI:1831809086
Name:ORIANTUS, WILSON
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:ORIANTUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 AVENUE S
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-2039
Mailing Address - Country:US
Mailing Address - Phone:561-667-2424
Mailing Address - Fax:
Practice Address - Street 1:3616 AVENUE S
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-2039
Practice Address - Country:US
Practice Address - Phone:561-667-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL092002251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services