Provider Demographics
NPI:1568853679
Name:MENESES, GEROLYN IVETTE
Entity Type:Individual
Prefix:MS
First Name:GEROLYN
Middle Name:IVETTE
Last Name:MENESES
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 1:503 E CHURCH ST
Mailing Address - Street 2:APT D
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4447
Mailing Address - Country:US
Mailing Address - Phone:941-323-9591
Mailing Address - Fax:
Practice Address - Street 1:259 BILL FRANCE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1316
Practice Address - Country:US
Practice Address - Phone:386-868-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator