Provider Demographics
NPI:1831898725
Name:TADORIAN, ALEXANDER ILIAS
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ILIAS
Last Name:TADORIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7743 SW 99TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2750
Mailing Address - Country:US
Mailing Address - Phone:860-817-5580
Mailing Address - Fax:
Practice Address - Street 1:1535 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3315
Practice Address - Country:US
Practice Address - Phone:860-817-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician