Provider Demographics
NPI:1871688879
Name:DELVIS A CELDRAN MD PA
Entity Type:Organization
Organization Name:DELVIS A CELDRAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DELVIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CELDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-335-3255
Mailing Address - Street 1:PO BOX 882229
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-2229
Mailing Address - Country:US
Mailing Address - Phone:772-335-3255
Mailing Address - Fax:772-335-3256
Practice Address - Street 1:543 NW LAKE WHITNEY PL
Practice Address - Street 2:UNIT 105
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1604
Practice Address - Country:US
Practice Address - Phone:772-335-3255
Practice Address - Fax:772-335-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275863600Medicaid
FLDG1486OtherRAILROAD MEDICARE
FL275863600Medicaid