Provider Demographics
NPI:1194405167
Name:DEOLIVIERA, TONIANN (RPT)
Entity type:Individual
Prefix:
First Name:TONIANN
Middle Name:
Last Name:DEOLIVIERA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 BRIGHT WATER DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7371
Mailing Address - Country:US
Mailing Address - Phone:631-902-6370
Mailing Address - Fax:
Practice Address - Street 1:2288 BRIGHT WATER DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7371
Practice Address - Country:US
Practice Address - Phone:631-902-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other