Healthcare Provider Details

I. General information

NPI: 1215097688
Provider Name (Legal Business Name): JOHN EMIL CALIENDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

IV. Provider business mailing address

350 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-7175
  • Fax:
Mailing address:
  • Phone: 386-676-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME22268
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: