Provider Demographics
NPI:1801393764
Name:EGINTON, NELLY A
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:A
Last Name:EGINTON
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 1:8506 CHERRY BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-8115
Mailing Address - Country:US
Mailing Address - Phone:305-527-6400
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:8506 CHERRY BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-8115
Practice Address - Country:US
Practice Address - Phone:305-527-6400
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician