Provider Demographics
NPI:1760988042
Name:DAVIN, ELLIOT
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:DAVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 PLANTATION KEY CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4664
Mailing Address - Country:US
Mailing Address - Phone:305-505-0828
Mailing Address - Fax:
Practice Address - Street 1:4917 ELI ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1717
Practice Address - Country:US
Practice Address - Phone:407-808-7837
Practice Address - Fax:407-494-6057
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician