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General NPI Number Information
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NPI Number | 1427394790
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Entity Type | Individual
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Provider Name | EDUARDO THEODORE AVERSANO ACUPINCTURIST
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Gender | Male
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 7301 W PALMETTO PARK RD STE 103C
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City | BOCA RATON
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State | FL
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Zip | 33433-3455
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Country | US
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Telephone | 561-395-2667
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Fax | 561-395-2685
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Provider Business Mailing Address
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Address Line | 7301 W PALMETTO PARK RD STE 103C
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City | BOCA RATON
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State | FL
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Zip | 33433-3455
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Country | US
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Telephone | 561-395-2667
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Fax | 561-395-2685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000366-1
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License Number State | NY
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