MEDICARE: EASTERSEALS FLORIDA, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	251S00000X	Community/Behavioral Health Agency
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1669314019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERSEALS FLORIDA, INC.

Provider Business Mailing Address
First Line	:	125 N RIDGEWOOD AVE STE 300
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-3284
Country	:	US
Telephone Number	:	386-944-7802
Fax Number	:

Provider Business Practice Location Address
First Line	:	3389 N STATE ST STE 1
Second Line	:
City	:	BUNNELL
State	:	FL
Zip	:	32110-4340
Country	:	US
Telephone Number	:	386-255-4568
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	RIKESHA BLAKE
Credential	:
Telephone Number	:	407-287-5185

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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