Provider Demographics
NPI:1639796634
Name:CELIS, SULY M
Entity Type:Individual
Prefix:
First Name:SULY
Middle Name:M
Last Name:CELIS
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 1:345 LAKE ARBOR DR # 345
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2110
Mailing Address - Country:US
Mailing Address - Phone:561-618-8472
Mailing Address - Fax:
Practice Address - Street 1:345 LAKE ARBOR DR # 345
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2110
Practice Address - Country:US
Practice Address - Phone:561-618-8472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty