Healthcare Provider Details

I. General information

NPI: 1952082562
Provider Name (Legal Business Name): CADEEM STEPHEN MARCELINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ALTAMONTE DR
ALTAMONTE SPG FL
32701-4802
US

IV. Provider business mailing address

190 INDEPENDENCE LN UNIT 435
MAITLAND FL
32751-5673
US

V. Phone/Fax

Practice location:
  • Phone: 407-542-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9420767
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11048410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: