Healthcare Provider Details

I. General information

NPI: 1750005013
Provider Name (Legal Business Name): CHELSEA MODESITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18735 3RD AVE
CLERMONT FL
34715-6836
US

IV. Provider business mailing address

18735 3RD AVE
CLERMONT FL
34715-6836
US

V. Phone/Fax

Practice location:
  • Phone: 352-875-5425
  • Fax:
Mailing address:
  • Phone: 352-875-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005382
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: