Provider Demographics
NPI:1073373155
Name:ULAN, MARIELLE A
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:A
Last Name:ULAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 ALAFAYA CLUB DR APT 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-6545
Mailing Address - Country:US
Mailing Address - Phone:813-297-2635
Mailing Address - Fax:
Practice Address - Street 1:12630 EVINGTON POINT DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4060
Practice Address - Country:US
Practice Address - Phone:813-297-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program