Healthcare Provider Details

I. General information

NPI: 1164644522
Provider Name (Legal Business Name): MRS. FELICIA HIMELSEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PINE CIRCLE
BOCA RATON FL
33432
US

IV. Provider business mailing address

130 PINE CIRCLE
BOCA RATON FL
33432
US

V. Phone/Fax

Practice location:
  • Phone: 561-361-0307
  • Fax: 561-393-6903
Mailing address:
  • Phone: 561-361-0307
  • Fax: 561-393-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ 3933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: