Healthcare Provider Details

I. General information

NPI: 1982869939
Provider Name (Legal Business Name): DEVON AVERY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21002NDST SW SWITE 5314
WASHINGTON DC
20593
US

IV. Provider business mailing address

2100 2ND ST SUITE 5314
APO AA
20593
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-5000
  • Fax: 305-535-4413
Mailing address:
  • Phone: 305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: