Healthcare Provider Details

I. General information

NPI: 1609438282
Provider Name (Legal Business Name): ERIC STEPHEN MASCELLINO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W BOYNTON BEACH BLVD STE F
BOYNTON BEACH FL
33426-3625
US

IV. Provider business mailing address

715 W BOYNTON BEACH BLVD STE F
BOYNTON BEACH FL
33426-3625
US

V. Phone/Fax

Practice location:
  • Phone: 561-734-3100
  • Fax: 561-374-7925
Mailing address:
  • Phone: 561-734-3100
  • Fax: 561-734-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO4302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: