Provider Demographics
NPI:1336767680
Name:CEREUS OSTEOPATHIC MEDICINE LLC
Entity Type:Organization
Organization Name:CEREUS OSTEOPATHIC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SELWACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO MBA
Authorized Official - Phone:954-257-4262
Mailing Address - Street 1:870 N COCOA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7588
Mailing Address - Country:US
Mailing Address - Phone:321-866-8847
Mailing Address - Fax:954-351-8349
Practice Address - Street 1:870 N COCOA BLVD STE A
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7588
Practice Address - Country:US
Practice Address - Phone:321-866-8847
Practice Address - Fax:954-351-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty