Fabio Andre Azeredo
Individual provider Active NPI Psychoanalysis Psychologist · Minnetonka, MN
NPI 1972258630 · NPPES record last updated Feb 21, 2022
Key facts
- NPI
- 1972258630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychoanalysis Psychologist 103TP0814X
- Practice address
- 250 Carlson Pkwy Apt 202
Minnetonka, MN 55305-5320 - Phone
- (612) 704-3339
- NPI assigned
- Feb 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalysis Psychologist | 103TP0814X | Yes |
Addresses
Primary practice location
250 Carlson Pkwy Apt 202
Minnetonka, MN 55305-5320
Mailing address
250 Carlson Pkwy Apt 202
Minnetonka, MN 55305-5320
Phone (612) 704-3339
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All providers in Minnetonka, MN · Psychoanalysis Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.