Provider Demographics
NPI:1952971228
Name:LAUDISIO, KAREN A
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:LAUDISIO
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:PO BOX 730983
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0983
Mailing Address - Country:US
Mailing Address - Phone:800-347-0054
Mailing Address - Fax:
Practice Address - Street 1:5889 S WILLIAMSON BLVD STE 1321
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6108
Practice Address - Country:US
Practice Address - Phone:800-347-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator