Healthcare Provider Details

I. General information

NPI: 1205895653
Provider Name (Legal Business Name): ELEANOR CHOY ABELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W MAIN ST NEW RIVER HEALTH @UNION COUNTY
LAKE BUTLER FL
32054-1642
US

IV. Provider business mailing address

395 W MAIN ST
LAKE BUTLER FL
32054-1642
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-3154
  • Fax: 386-243-6500
Mailing address:
  • Phone: 386-496-3154
  • Fax: 386-243-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME79371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: