Healthcare Provider Details

I. General information

NPI: 1083707079
Provider Name (Legal Business Name): ANO & ANO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 S RIDGEWOOD AVE
SOUTH DAYTONA FL
32119-2240
US

IV. Provider business mailing address

2089 S RIDGEWOOD AVE
SOUTH DAYTONA FL
32119-2240
US

V. Phone/Fax

Practice location:
  • Phone: 386-761-5682
  • Fax: 386-760-4142
Mailing address:
  • Phone: 386-761-5682
  • Fax: 386-760-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0020477
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0029894
License Number StateFL

VIII. Authorized Official

Name: FERMIN ANO
Title or Position: PRESIDENT
Credential: MD
Phone: 386-761-5682