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NPI Code Detail

MEDICARE: EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.

MEDICARE: EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1538997556
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Provider Business Mailing Address
First Line : 1219 DUNN AVE
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-2405
Country : US
Telephone Number : 386-255-4568
Fax Number : 386-258-7677
Provider Business Practice Location Address
First Line : 160 CYPRESS POINT PKWY STE B205
Second Line :
City : PALM COAST
State : FL
Zip : 32164-8437
Country : US
Telephone Number : 386-878-4220
Fax Number : 386-258-7677
Authorized Official
Title or Position : ACCOUNTING MANAGER
Name : MICHELE WALLENS
Credential :
Telephone Number : 386-255-4568
Provider Enumeration Date : 07/22/2024
Last Update Date : 07/22/2024

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