Provider Demographics
NPI:1578206934
Name:BOTROS, DEMIANA
Entity type:Individual
Prefix:
First Name:DEMIANA
Middle Name:
Last Name:BOTROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MARRIOTT DR STE 315N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-5020
Mailing Address - Country:US
Mailing Address - Phone:615-258-8400
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:555 MARRIOTT DR STE 315N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-5020
Practice Address - Country:US
Practice Address - Phone:615-258-8400
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician