Organization
DR BALLESTER, PROFESSIONAL LIMITED COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDRA MARIE BALLESTER PSY.D. (LICENSED PSYCHOLOGIST/ MANAGER)
(863) 424-0194
Entity
Organization
Contact information
Practice address
602 COVENTRY RD, DAVENPORT, FL 33897-3899
(863) 424-0194
Mailing address
PO BOX 135157, CLERMONT, FL 34713-5157
(863) 424-0194
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY 7428
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548439409
NPI
FL
Enumeration date
02/25/2008
Last updated
03/26/2015
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