Healthcare Provider Details

I. General information

NPI: 1861177545
Provider Name (Legal Business Name): PEDIATRICS PLUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 26TH ST
LYNN HAVEN FL
32444-4713
US

IV. Provider business mailing address

301 W 26TH ST
LYNN HAVEN FL
32444-4713
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-5371
  • Fax: 850-872-9558
Mailing address:
  • Phone: 850-769-5371
  • Fax: 850-872-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MANDY WALSINGHAM
Title or Position: BILLING DEPT MANAGER
Credential:
Phone: 850-769-5371