Provider Demographics
NPI:1780354803
Name:ALCOTT, FAYANNIE IONIE
Entity type:Individual
Prefix:
First Name:FAYANNIE
Middle Name:IONIE
Last Name:ALCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 59TH DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-6048
Mailing Address - Country:US
Mailing Address - Phone:305-290-9903
Mailing Address - Fax:
Practice Address - Street 1:5725 59TH DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-6048
Practice Address - Country:US
Practice Address - Phone:305-290-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion