Healthcare Provider Details

I. General information

NPI: 1487701900
Provider Name (Legal Business Name): HELEN M DALLAIRE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. HELEN M CIAMPI

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 S STARFISH AVE
FLORAL CITY FL
34436-5603
US

IV. Provider business mailing address

PO BOX 587
FLORAL CITY FL
34436-0587
US

V. Phone/Fax

Practice location:
  • Phone: 352-341-2867
  • Fax:
Mailing address:
  • Phone: 352-341-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA33308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: