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NPI Code Detail

MEDICARE: AVA N WELLER

MEDICARE: AVA N WELLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianFL

General Provider Information

NPI Number : 1558119040
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVA N WELLER
Provider Business Mailing Address
First Line : 3107 SUMMER HOUSE DR
Second Line :
City : VALRICO
State : FL
Zip : 33594-7640
Country : US
Telephone Number : 813-694-0556
Fax Number :
Provider Business Practice Location Address
First Line : 609 W WATERS AVE
Second Line :
City : TAMPA
State : FL
Zip : 33604-2901
Country : US
Telephone Number : 727-492-5369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2024
Last Update Date : 06/25/2024

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Directions to “ AVA N WELLER ” Practice Location

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