Healthcare Provider Details

I. General information

NPI: 1164948360
Provider Name (Legal Business Name): HEART RHYTHM SPECIALISTS AT DAYTONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MEMORIAL MEDICAL PKWY STE 300
DAYTONA BEACH FL
32117-5170
US

IV. Provider business mailing address

305 MEMORIAL MEDICAL PKWY STE 300
DAYTONA BEACH FL
32117-5170
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-1023
  • Fax: 386-263-2996
Mailing address:
  • Phone: 386-672-1023
  • Fax: 386-263-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. YVETTE S ANDERSON
Title or Position: CONSULTING MANAGER
Credential:
Phone: 386-316-0955