Healthcare Provider Details

I. General information

NPI: 1932345527
Provider Name (Legal Business Name): LAVAUD FEVRY ADMINISTRATOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 SILVER STAR RD STE 210
ORLANDO FL
32818-3140
US

IV. Provider business mailing address

6900 SILVER STAR RD SUITE 210
ORLANDO FL
32818-3140
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-8766
  • Fax: 407-704-8763
Mailing address:
  • Phone: 407-704-8766
  • Fax: 407-704-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberHCC6718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: