Provider Demographics
NPI:1306087648
Name:HESCHMEYER, MARIRYAN (DOM)
Entity type:Individual
Prefix:
First Name:MARIRYAN
Middle Name:
Last Name:HESCHMEYER
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 HARBOR DR S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2610
Mailing Address - Country:US
Mailing Address - Phone:352-262-6885
Mailing Address - Fax:
Practice Address - Street 1:901 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1646
Practice Address - Country:US
Practice Address - Phone:727-551-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA157171100000X
FL2989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist