Provider Demographics
NPI:1609438282
Name:MASCELLINO, ERIC STEPHEN (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:STEPHEN
Last Name:MASCELLINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8485 SW 40TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3262
Mailing Address - Country:US
Mailing Address - Phone:305-551-3412
Mailing Address - Fax:305-551-1945
Practice Address - Street 1:8485 SW 40TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3262
Practice Address - Country:US
Practice Address - Phone:305-551-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4302213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO4302OtherFLORIDA LICENSE