Healthcare Provider Details

I. General information

NPI: 1942658802
Provider Name (Legal Business Name): INTELLIHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 GULF OF MEXICO DR SUITE 105
LONGBOAT KEY FL
34228-2048
US

IV. Provider business mailing address

5380 GULF OF MEXICO DR SUITE 105
LONGBOAT KEY FL
34228-2048
US

V. Phone/Fax

Practice location:
  • Phone: 941-238-0266
  • Fax:
Mailing address:
  • Phone: 941-238-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANAE S PUFTA-O'LEARY
Title or Position: OWNER
Credential:
Phone: 941-238-0266