MEDICARE: MRS. EVELYN ELIZABETH CLEGG

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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

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

General Provider Information

NPI Number	:	1659670446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVELYN ELIZABETH CLEGG

Provider Business Mailing Address
First Line	:	4250 ALAFAYA TRL STE 212
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-9424
Country	:	US
Telephone Number	:	407-790-4007
Fax Number	:

Provider Business Practice Location Address
First Line	:	934 N MAGNOLIA AVE STE 327
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-3840
Country	:	US
Telephone Number	:	407-496-2192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2011
Last Update Date	:	12/03/2023

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