Provider Demographics
NPI:1710014865
Name:GELLYA, INC
Entity Type:Organization
Organization Name:GELLYA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MNASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-816-1513
Mailing Address - Street 1:5181 US HIGHWAY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-0531
Mailing Address - Country:US
Mailing Address - Phone:863-816-1513
Mailing Address - Fax:813-816-2253
Practice Address - Street 1:5181 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-0531
Practice Address - Country:US
Practice Address - Phone:863-816-1513
Practice Address - Fax:813-816-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1160332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1256740001Medicare NSC