Healthcare Provider Details

I. General information

NPI: 1952372435
Provider Name (Legal Business Name): CELENE ANGELEE FYFFE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 WINTER SPRINGS BLVD
OVIEDO FL
32765-9347
US

IV. Provider business mailing address

2060 WINTER SPRINGS BLVD
OVIEDO FL
32765-9347
US

V. Phone/Fax

Practice location:
  • Phone: 850-270-3307
  • Fax:
Mailing address:
  • Phone: 850-270-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY10461
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1171
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: