MEDICARE: AVERY NICOLE SAPORITO MD

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	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	U5507	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084N0400X	Neurology Physician	U5507	TX

General Provider Information

NPI Number	:	1477013829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY NICOLE SAPORITO MD

Provider Business Mailing Address
First Line	:	9101 N CENTRAL EXPY STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-6009
Country	:	US
Telephone Number	:	214-820-9272
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 N CENTRAL EXPY STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-6009
Country	:	US
Telephone Number	:	214-820-9272
Fax Number	:

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

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	09/24/2024

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Directions to “ AVERY NICOLE SAPORITO MD” Practice Location

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