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General NPI Number Information
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NPI Number | 1033886593
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Entity Type | Individual
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Provider Name | MOUSTAFA ELSEBEY MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 550 POPE AVE NW STE 100
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4679
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Country | US
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Telephone | 863-293-2144
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Fax | 863-293-3732
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Provider Business Mailing Address
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Address Line | 900 S PINE ISLAND RD STE 800
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City | PLANTATION
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State | FL
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Zip | 33324-3923
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Country | US
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Telephone | 954-967-6400
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Fax | 954-337-5755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | TRN34193
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME164780
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License Number State | FL
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