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General NPI Number Information
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NPI Number | 1124217328
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Entity Type | Organization
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Legal Business Name | MELBOURNE AND PALM BAY NEPHROLOGY INC.
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 7770 BAY ST SUITE 13
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City | SEBASTIAN
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State | FL
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Zip | 32958-3427
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Country | US
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Telephone | 772-581-2750
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Fax | 772-581-8362
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Provider Business Mailing Address
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Address Line | 7770 BAY ST SUITE 13
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City | SEBASTIAN
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State | FL
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Zip | 32958-3427
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Country | US
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Telephone | 772-581-2750
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Fax | 772-581-8362
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Authorized Official
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Title or Position | OWNER, SOLE ENTITY
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Name | DR. MARCHELLE KAY HOFELDT
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Credential | M.D.
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Telephone | 772-581-2750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME82565
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License Number State | FL
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