Healthcare Provider Details

I. General information

NPI: 1184562886
Provider Name (Legal Business Name): EASTERSEALS FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N WICKHAM RD STE 1
MELBOURNE FL
32935-2330
US

IV. Provider business mailing address

125 N RIDGEWOOD AVE STE 300
DAYTONA BEACH FL
32114-3284
US

V. Phone/Fax

Practice location:
  • Phone: 321-634-3688
  • Fax:
Mailing address:
  • Phone: 386-944-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: RIKESHA BLAKE
Title or Position: CFO
Credential:
Phone: 407-287-5185