Healthcare Provider Details

I. General information

NPI: 1811288228
Provider Name (Legal Business Name): NICOLE LIVAUDAIS ABBRACCIAMENTO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 LEE RD
WINTER PARK FL
32789-1750
US

IV. Provider business mailing address

875 WILMETTE AVE APT 807
ORMOND BEACH FL
32174-9518
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-7451
  • Fax:
Mailing address:
  • Phone: 386-682-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: