Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELE WALLENS (ACCOUNTING MANAGER)
(386) 255-4568
Entity
Organization
Contact information
Practice address
3804 PIONEER TRL, NEW SMYRNA BEACH, FL 32168-8784
(386) 944-7805
(386) 258-7677
Mailing address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 944-7805
(386) 258-7677
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
Other
Enumeration date
03/10/2023
Last updated
03/10/2023
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