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Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Active
Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE WALLENS (ACCOUNTING MANAGER)
(386) 255-4568
Entity
Organization
Contact information
Practice address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 944-7805
Mailing address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 944-7805
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
Other
Enumeration date
06/24/2022
Last updated
06/24/2022
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