Healthcare Provider Details

I. General information

NPI: 1104529023
Provider Name (Legal Business Name): EMMY ROSINE MATHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 STERLING SILVER BLVD STE 102
DELTONA FL
32725-4332
US

IV. Provider business mailing address

1745 STERLING SILVER BLVD STE 102
DELTONA FL
32725-4332
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-7668
  • Fax:
Mailing address:
  • Phone: 386-917-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: