Healthcare Provider Details

I. General information

NPI: 1003602418
Provider Name (Legal Business Name): SIBELIUS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 N WICKHAM RD STE 110
MELBOURNE FL
32940-7323
US

IV. Provider business mailing address

1175 HIGHWAY A1A APT 508
SATELLITE BEACH FL
32937-2422
US

V. Phone/Fax

Practice location:
  • Phone: 321-779-9838
  • Fax: 321-779-4502
Mailing address:
  • Phone: 321-290-0727
  • Fax: 321-779-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZAHRA YAGHOOTI MCTAMMANY
Title or Position: OWNER
Credential: MD
Phone: 321-290-0727