Provider Demographics
NPI:1730582578
Name:BAKARDJIEV-BERRIOS, NEISHA
Entity type:Individual
Prefix:
First Name:NEISHA
Middle Name:
Last Name:BAKARDJIEV-BERRIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NEISHA
Other - Middle Name:
Other - Last Name:BERRIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 N SUMMERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2900
Mailing Address - Country:US
Mailing Address - Phone:954-937-8154
Mailing Address - Fax:
Practice Address - Street 1:8162 PRESTBURY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6313
Practice Address - Country:US
Practice Address - Phone:954-937-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3268171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist