MEDICARE: DAVID ALISHAYEV

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	122300000X	Dentist	27895	FL

General Provider Information

NPI Number	:	1821780339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALISHAYEV

Provider Business Mailing Address
First Line	:	5170 SW 40TH AVE APT 1E
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33314-5753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 SE 2ND AVE STE 336
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-1543
Country	:	US
Telephone Number	:	305-645-4166
Fax Number	:

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

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	08/10/2023

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Directions to “ DAVID ALISHAYEV ” Practice Location

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