MEDICARE: MIAUSETTE VALERIE ANTOINE MSS,CAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		FL

General Provider Information

NPI Number	:	1265183529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIAUSETTE VALERIE ANTOINE MSS,CAP

Provider Business Mailing Address
First Line	:	3928 S NOVA RD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4911
Country	:	US
Telephone Number	:	386-822-9941
Fax Number	:	386-788-4519

Provider Business Practice Location Address
First Line	:	3928 S NOVA RD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4911
Country	:	US
Telephone Number	:	386-822-9941
Fax Number	:	386-788-4519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/18/2022

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