Healthcare Provider Details

I. General information

NPI: 1275909053
Provider Name (Legal Business Name): AMY ELLER BEER ACUPUNCTUREPHYSICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 DORA DR
MOUNT DORA FL
32757-7014
US

IV. Provider business mailing address

5671 DORA DR
MOUNT DORA FL
32757-7014
US

V. Phone/Fax

Practice location:
  • Phone: 407-616-6911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 3657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: