=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689646929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY JAY HELLER DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2006
-----------------------------------------------------
Last Update Date | 06/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 N CLYDE MORRIS BLVD
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-239-8700
-----------------------------------------------------
Fax | 386-239-7070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 N CLYDE MORRIS BLVD
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-239-8700
-----------------------------------------------------
Fax | 386-239-7070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | OS6226
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------