Organization · NPI-2

Easterseals Northeast Central Florida, INC.

Pediatrics, Developmental - Behavioral Pediatrics · Daytona Beach, FL

NPI number1699407015

StatusActive

Last updated in NPPESJun 24, 2022

Details

NPI: 1699407015
Entity type: Organization (NPI-2)
Legal business name: Easterseals Northeast Central Florida, INC.
Organization subpart: No
Enumeration date: Jun 24, 2022
Certification date: Jun 24, 2022
Last updated: Jun 24, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
2080P0006X	Pediatrics, Developmental - Behavioral Pediatrics	–	–	Yes

Practice location

1219 Dunn Ave
Daytona Beach, FL 32114-2405

Phone 386-944-7805

Mailing address

1219 Dunn Ave
Daytona Beach, FL 32114-2405

Phone 386-944-7805

Authorized official

Michele Wallens
Accounting Manager
3862554568

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