Provider Demographics
NPI:1306933353
Name:BEASLEY, SVETLANA ANA (AP)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:ANA
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 ZOLTAN DR.
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780
Mailing Address - Country:US
Mailing Address - Phone:321-720-8931
Mailing Address - Fax:321-268-3939
Practice Address - Street 1:1059 CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780
Practice Address - Country:US
Practice Address - Phone:321-720-8931
Practice Address - Fax:321-268-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2127171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist