MEDICARE: DR. JODI ELLEN STAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME 85603	FL
2	2084P0015X	Psychosomatic Medicine Physician	ME85603	FL
3	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	ME85603	FL
4	2084P0804X	Child & Adolescent Psychiatry Physician	ME 85603	FL
5	2084P0800X	Psychiatry Physician	ME 85603	FL

General Provider Information

NPI Number	:	1184718504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI ELLEN STAR M.D.

Provider Business Mailing Address
First Line	:	3319 STATE ROAD 7
Second Line	:	STE 210
City	:	WELLINGTON
State	:	FL
Zip	:	33449
Country	:	US
Telephone Number	:	561-422-3314
Fax Number	:	561-422-3315

Provider Business Practice Location Address
First Line	:	GUIDING LIGHT WELLNESS CENTER
Second Line	:	3319 STATE ROAD 7 STE 210
City	:	WELLINGTON
State	:	FL
Zip	:	33449
Country	:	US
Telephone Number	:	561-422-3314
Fax Number	:	561-422-3315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/01/2021

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Directions to “ DR. JODI ELLEN STAR M.D.” Practice Location

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