Healthcare Provider Details

I. General information

NPI: 1386454080
Provider Name (Legal Business Name): AVIA TOTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4195 W NEW HAVEN AVE STE 7
WEST MELBOURNE FL
32904-1701
US

IV. Provider business mailing address

3630 MEADOWLARK WAY
MELBOURNE FL
32904-9502
US

V. Phone/Fax

Practice location:
  • Phone: 321-266-7485
  • Fax: 321-290-9983
Mailing address:
  • Phone: 321-266-7485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER THAVER
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 321-266-7485