Healthcare Provider Details

I. General information

NPI: 1700712445
Provider Name (Legal Business Name): TEAK HAVEN COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 MALABAR RD SE # 208
PALM BAY FL
32907-3239
US

IV. Provider business mailing address

1150 MALABAR RD SE # 208
PALM BAY FL
32907-3239
US

V. Phone/Fax

Practice location:
  • Phone: 321-292-9063
  • Fax:
Mailing address:
  • Phone: 321-292-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ALYSSA M PAMENTER
Title or Position: OWNER
Credential: APRN
Phone: 321-292-9063