Provider Demographics
NPI:1013923028
Name:PELTA, ELY D (MD)
Entity Type:Individual
Prefix:DR
First Name:ELY
Middle Name:D
Last Name:PELTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5441 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4640
Mailing Address - Country:US
Mailing Address - Phone:954-345-8733
Mailing Address - Fax:954-345-8233
Practice Address - Street 1:5441 N UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4640
Practice Address - Country:US
Practice Address - Phone:954-345-8733
Practice Address - Fax:954-345-8233
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME598402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268660100Medicaid
FL17762YMedicare PIN
FL268660100Medicaid