Provider Demographics
NPI:1962702415
Name:FEDISON, NEIDA (LAC,DIPLAC, OMD)
Entity type:Individual
Prefix:
First Name:NEIDA
Middle Name:
Last Name:FEDISON
Suffix:
Gender:F
Credentials:LAC,DIPLAC, OMD
Other - Prefix:
Other - First Name:NEIDA
Other - Middle Name:
Other - Last Name:CASERES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC,DIPLAC
Mailing Address - Street 1:2123 FERGUSON LOOP
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4463
Mailing Address - Country:US
Mailing Address - Phone:786-303-1123
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:786-303-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2790171100000X
VA0121000812171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist