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General NPI Number Information
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NPI Number | 1447741749
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Entity Type | Organization
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Legal Business Name | EXCELLENCE HEALTH, LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1630 MASON AVE STE C
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4547
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Country | US
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Telephone | 386-238-9064
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Fax | 386-238-9063
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Provider Business Mailing Address
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Address Line | 1630 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | ANGELA BRADSHAW
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Credential |
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Telephone | 386-238-9064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME94169
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License Number State | FL
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