Healthcare Provider Details

I. General information

NPI: 1184452658
Provider Name (Legal Business Name): ELLIOTTNELL PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 W GORE ST FL 5
ORLANDO FL
32806-1134
US

IV. Provider business mailing address

32 W GORE ST FL 5
ORLANDO FL
32806-1134
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3820
  • Fax: 321-843-6836
Mailing address:
  • Phone: 321-841-3820
  • Fax: 321-843-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY13340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: