Individual
ELLORA JALALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1771
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
ME129992
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019418500
—
FL
01
—
IU225Z
MEDICARE
FL
Enumeration date
04/30/2013
Last updated
05/14/2018
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