Healthcare Provider Details

I. General information

NPI: 1760204754
Provider Name (Legal Business Name): EPIC ICONIC HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 N STATE RD 434 SUITE 2147
ALTAMONTE SPRINGS FL
32714
US

IV. Provider business mailing address

499 N STATE RD 434 SUITE 2147
ALTAMONTE SPRINGS FL
32714
US

V. Phone/Fax

Practice location:
  • Phone: 407-723-9658
  • Fax:
Mailing address:
  • Phone: 407-723-9658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHELANDO DOWNER
Title or Position: OWNER
Credential:
Phone: 407-723-9658