Healthcare Provider Details

I. General information

NPI: 1396726329
Provider Name (Legal Business Name): PEDIATRICS IN BREVARD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 W COCOA BEACH CSWY
COCOA BEACH FL
32931-3577
US

IV. Provider business mailing address

699 W COCOA BEACH CSWY
COCOA BEACH FL
32931-3577
US

V. Phone/Fax

Practice location:
  • Phone: 321-784-5437
  • Fax: 321-799-1231
Mailing address:
  • Phone: 321-784-5437
  • Fax: 321-799-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. KAREN ALLISON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 321-636-3066