MEDICARE: WELLHAVEN HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician
2	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1407641582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLHAVEN HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	274 WILSHIRE BLVD STE 277
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-5368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 WALTHAM AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-4207
Country	:	US
Telephone Number	:	407-870-3434
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NESTOR FONSECA
Credential	:
Telephone Number	:	305-298-2123

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	09/08/2025

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Directions to “WELLHAVEN HEALTH SERVICES INC ” Practice Location

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