Healthcare Provider Details

I. General information

NPI: 1437318367
Provider Name (Legal Business Name): PEDIATRIC WIZARDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W EAU GALLIE BLVD SUITE C
MELBOURNE FL
32935-5300
US

IV. Provider business mailing address

1310 W EAU GALLIE BLVD SUITE C
MELBOURNE FL
32935-5300
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-3434
  • Fax: 321-255-0963
Mailing address:
  • Phone: 321-255-3434
  • Fax: 321-255-0963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME82113
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID ANDREW HELFT
Title or Position: OWNER
Credential: MD
Phone: 321-255-3434