Provider Demographics
NPI:1730297151
Name:HELLER, DERETHA J
Entity Type:Individual
Prefix:MRS
First Name:DERETHA
Middle Name:J
Last Name:HELLER
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 1:6515 MAN O WAR TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-1615
Mailing Address - Country:US
Mailing Address - Phone:850-894-2248
Mailing Address - Fax:
Practice Address - Street 1:6515 MAN O WAR TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-1615
Practice Address - Country:US
Practice Address - Phone:850-894-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist