Healthcare Provider Details

I. General information

NPI: 1952430811
Provider Name (Legal Business Name): ELLA MARIE GUASTAVINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 S ACCESS RD
ENGLEWOOD FL
34224-8644
US

IV. Provider business mailing address

7227 TEABERRY ST
ENGLEWOOD FL
34224-8051
US

V. Phone/Fax

Practice location:
  • Phone: 941-416-2864
  • Fax: 650-265-4616
Mailing address:
  • Phone: 941-416-2864
  • Fax: 650-265-4616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberME0059964
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number222304
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number185936
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0059964
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberME0059964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: