LILIYA HERETSUN-ROUSSONICOLOS (NPI# 1407464506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407464506 |
| Entity Type | Individual |
| Full Name | LILIYA HERETSUN-ROUSSONICOLOS |
| Practice Address |
1488 Se Village Green Dr Port St Lucie FL 34952-3411 |
| Practice Telephone | 7223011497 |
| Practice Fax Number | 3216768508 |
| Mailing Telephone | 7727774745 |
| Mailing Fax Number | 7727774833 |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2020-10-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | FL | Suppliers |
| Street Address |
1488 SE VILLAGE GREEN DR |
| City | PORT ST LUCIE |
| State | FL |
| Zip Code | 34952-3411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215587068 | Carehere LLC | Family Medicine | Carehere Clinic- St. Lucie Psl, 1680 Se Lyngate Drive, Port St Lucie, FL 34952 | 2019-09-13 |
| 1255998274 | Morningside Alf | Assisted Living Facility | 2233 Se Mroningside Alf, Port Saint Lucie, FL 34952 | 2019-05-24 |
| 1336611870 | Med Braces and Supplies, LLC | Durable Medical Equipment & Medical Supplies | 1484 Se Village Green Dr, Port St Lucie, FL 34952 | 2018-12-21 |
| 1689143794 | The Gift of Recovery, LLC | Counselor | 1801 Sw Hillmoor Drive, Suite C-101, Port St. Lucie, FL 34952 | 2018-11-19 |
| 1457830853 | Cathy L Sonier | Counselor | 357 Brazilian Circle, Port St Lucie, FL 34952 | 2018-08-07 |
| 1548756661 | Blo 7 Diabetes Institute Inc | Nutritionist | 1700 Sw Hillmoor Dr., Suite 305, Port St. Lucie, FL 34952 | 2018-07-02 |
| 1780194464 | Doctor's Choice Medical Center | Clinic/Center | 9164 S Us Highway 1, Port St Lucie, FL 34952 | 2017-10-06 |
| 1801305644 | Thandiwe Daley | Behavior Technician | 1935 Se Hillmoor Drive, Apt#159, Port St Lucie, FL 34952 | 2017-09-25 |
| 1700309408 | Lagrand Evan Andrews | Assistant Behavior Analyst | 265 Se Lenard Rd. Apartment 307, Port St. Lucie, FL 34952 | 2017-07-25 |
| 1578085148 | Lavetta S Ivey | Behavior Technician | 7190 Us Federal Hwy 1, Port Saint Lucie, FL 34952 | 2017-07-14 |
| Find all providers in zip 34952 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407498041 | Anointed Medical Supplies, LLC | Durable Medical Equipment & Medical Supplies | 2727 Se Morningside Blvd, Port St Lucie, FL 34952-5705 | 2019-10-15 |
| 1588205132 | Ark Medical Associates, LLC | Durable Medical Equipment & Medical Supplies | 2400 Se Veterans Memorial Pkwy Ste 210, Port St Lucie, FL 34952-4890 | 2019-10-04 |
| 1336611870 | Med Braces and Supplies, LLC | Durable Medical Equipment & Medical Supplies | 1484 Se Village Green Dr, Port St Lucie, FL 34952 | 2018-12-21 |
| 1912478603 | L&p Health Supplies, LLC | Durable Medical Equipment & Medical Supplies | 698 Sw Port St Lucie Blvd Ste 105, Port St Lucie, FL 34953-1565 | 2018-12-06 |
| 1205337896 | Reign Medical Marketing | Durable Medical Equipment & Medical Supplies | 2049 Sw Savage Blvd, Port St Lucie, FL 34953-2789 | 2018-02-28 |
| 1700335312 | Wal-mart Stores East, Lp | Durable Medical Equipment & Medical Supplies | 3045 Sw Port St Lucie Blvd, Port St Lucie, FL 34953-0000 | 2016-09-23 |
| 1861859456 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 902 Sw Saint Lucie West Blvd, Port St Lucie, FL 34986-1766 | 2016-01-27 |
| 1801252820 | Suresh Sukhraj | Durable Medical Equipment & Medical Supplies | 6979 Hancock Dr, Port St Lucie, FL 34952-8207 | 2016-01-06 |
| 1619228350 | A & E Home Supply Inc | Durable Medical Equipment & Medical Supplies | 10506 S Us Highway 1, Port St Lucie, FL 34952-5603 | 2012-09-20 |
| 1811294234 | Azof Enterprises Inc | Durable Medical Equipment & Medical Supplies | 1936 Se Port St Lucie Blvd, Port St Lucie, FL 34952-5509 | 2011-02-21 |
| Find all providers in PORT ST LUCIE | ||||
| City | PORT ST LUCIE |
| Zip Code | 34952 |
Please comment or provide details below to improve the information on LILIYA HERETSUN-ROUSSONICOLOS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.