Provider Demographics
NPI:1851714620
Name:DEVELOPMENTAL BEHAVIORAL PEDIATRICS
Entity Type:Organization
Organization Name:DEVELOPMENTAL BEHAVIORAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:CELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-765-5437
Mailing Address - Street 1:950 S WINTER PARK DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5457
Mailing Address - Country:US
Mailing Address - Phone:407-765-5437
Mailing Address - Fax:888-972-7981
Practice Address - Street 1:950 S WINTER PARK DR
Practice Address - Street 2:SUITE 302
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5457
Practice Address - Country:US
Practice Address - Phone:407-765-5437
Practice Address - Fax:888-972-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1000982080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty