Provider Demographics
NPI:1043450067
Name:ENGELMAN, DAVID (MA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ENGELMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1081
Mailing Address - Country:US
Mailing Address - Phone:727-492-1253
Mailing Address - Fax:813-854-6188
Practice Address - Street 1:302 VISTA LAKE CIR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0080
Practice Address - Country:US
Practice Address - Phone:727-492-1253
Practice Address - Fax:727-350-3255
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-03-1275103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017523500Medicaid