Provider Demographics
NPI:1013708650
Name:ALLEN, NELLY ALLEY (MBBS)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:ALLEY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:NELLY
Other - Middle Name:ALLEY
Other - Last Name:EJOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:6325 US HIGHWAY 27 N STE 201
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8226
Mailing Address - Country:US
Mailing Address - Phone:863-382-9600
Mailing Address - Fax:
Practice Address - Street 1:6325 US HIGHWAY 27 N STE 201
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8226
Practice Address - Country:US
Practice Address - Phone:863-382-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41897390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41897OtherFLORIDA MEDICAL BOARD