Healthcare Provider Details

I. General information

NPI: 1689655607
Provider Name (Legal Business Name): PEDIATRICS IN BREVARD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 W HIBISCUS BLVD
MELBOURNE FL
32901-2616
US

IV. Provider business mailing address

1755 W HIBISCUS BLVD
MELBOURNE FL
32901-2616
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-5437
  • Fax: 321-724-5570
Mailing address:
  • Phone: 321-724-5437
  • Fax: 321-724-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN ALLISON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 321-636-3066