Healthcare Provider Details

I. General information

NPI: 1528644507
Provider Name (Legal Business Name): PETER PELOBELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13900 NE 3RD CT
NORTH MIAMI FL
33161-2898
US

IV. Provider business mailing address

13900 NE 3RD CT
MIAMI FL
33161-2898
US

V. Phone/Fax

Practice location:
  • Phone: 305-893-2288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: