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General NPI Number Information
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NPI Number | 1053748293
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Entity Type | Organization
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Legal Business Name | LADELE HEALTH
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 1982 STATE ROAD 44 SUITE 162
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-8349
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Country | US
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Telephone | 386-320-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 1982 STATE ROAD 44 NUM 162
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168
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Country | US
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Telephone | 386-320-3233
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | DR. DAHOMEY R ABANISHE
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Credential | PHD
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Telephone | 386-320-3233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 8868
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License Number State | FL
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