Healthcare Provider Details

I. General information

NPI: 1710014865
Provider Name (Legal Business Name): GELLYA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5181 US HIGHWAY 98 N
LAKELAND FL
33809-0531
US

IV. Provider business mailing address

5181 US HIGHWAY 98 N
LAKELAND FL
33809-0531
US

V. Phone/Fax

Practice location:
  • Phone: 863-816-1513
  • Fax: 813-816-2253
Mailing address:
  • Phone: 863-816-1513
  • Fax: 813-816-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1160
License Number StateFL

VIII. Authorized Official

Name: MR. GHASSAN MNASSA
Title or Position: PRESIDENT
Credential:
Phone: 863-816-1513