Provider Demographics
NPI:1700471232
Name:CELESTIN, MYLDRIDE
Entity Type:Individual
Prefix:MISS
First Name:MYLDRIDE
Middle Name:
Last Name:CELESTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13517 LARANJA ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8707
Mailing Address - Country:US
Mailing Address - Phone:321-695-7486
Mailing Address - Fax:
Practice Address - Street 1:13517 LARANJA ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8707
Practice Address - Country:US
Practice Address - Phone:321-695-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment