Organization
GAVIOTA DIALYSIS, LLC
Active
Other names
Deltona Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1200 DELTONA BLVD, STE 26, DELTONA, FL 32725-6389
(386) 574-0225
(386) 574-6460
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015058200
—
FL
Enumeration date
02/16/2015
Last updated
02/03/2026
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