Healthcare Provider Details

I. General information

NPI: 1225512791
Provider Name (Legal Business Name): SCHENELL THOMPSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 VICTORIA COMMONS BLVD STE 102
DELAND FL
32724-7722
US

IV. Provider business mailing address

6800 N DALE MABRY HWY STE 186
TAMPA FL
33614-3998
US

V. Phone/Fax

Practice location:
  • Phone: 386-740-4082
  • Fax: 386-734-8512
Mailing address:
  • Phone: 813-839-3438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: