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1509 N Harbor City Blvd Melbourne FL 32935-6572 | |
(321) 253-0846 | |
(321) 253-1004 |
Full Name | |
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Speciality | Clinic/center |
Location | 1509 N Harbor City Blvd, Melbourne, Florida |
Authorized Official Name and Position | Jessica Seidita (CEO) |
Authorized Official Contact | 3212598928 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1495 N Harbor City Blvd Ste E Melbourne FL 32935-6572 Ph: (321) 253-0846 | 1509 N Harbor City Blvd Melbourne FL 32935-6572 Ph: (321) 253-0846 |
NPI Number | 1013178748 |
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Provider Enumeration Date | 06/25/2008 |
Last Update Date | 01/08/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013178748 | NPI | - | NPPES |
034139800 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Donald H. Dehaven Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8057 Spyglass Hill Rd, Unit 104, Melbourne, FL 32940 Phone: 321-622-8943 Fax: 321-622-8945 | |
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