Provider Demographics
NPI:1629570353
Name:PELLOT, NELIANNE EVELYN
Entity Type:Individual
Prefix:
First Name:NELIANNE
Middle Name:EVELYN
Last Name:PELLOT
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 1:9150 SW 21ST DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7925
Mailing Address - Country:US
Mailing Address - Phone:772-285-1144
Mailing Address - Fax:844-652-8088
Practice Address - Street 1:9150 SW 21ST DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7925
Practice Address - Country:US
Practice Address - Phone:772-285-1144
Practice Address - Fax:844-652-8088
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023082500Medicaid