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NPI Code Detail

MEDICARE: STA'CHA BECKTON B.S.

MEDICARE: STA'CHA BECKTON B.S.
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
1390200000XStudent in an Organized Health Care Education/Training Program

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548703689
Entity Type Code : Individual
Provider Name (Legal Business Name) : STA'CHA BECKTON B.S.
Provider Business Mailing Address
First Line : 175 MIDDLE ST
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-3625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1128 BEVILLE RD STE A
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-5769
Country : US
Telephone Number : 386-267-3161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2016
Last Update Date : 11/21/2016

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Directions to “ STA'CHA BECKTON B.S.” Practice Location

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