Provider Demographics
NPI:1801099155
Name:DR ELENA COELLO-JEMMALI INC
Entity type:Organization
Organization Name:DR ELENA COELLO-JEMMALI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:COELLO JEMMALI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-233-2010
Mailing Address - Street 1:14707 S DIXIE HWY
Mailing Address - Street 2:#211
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7948
Mailing Address - Country:US
Mailing Address - Phone:305-233-2010
Mailing Address - Fax:305-233-2011
Practice Address - Street 1:14707 S DIXIE HWY
Practice Address - Street 2:#211
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7948
Practice Address - Country:US
Practice Address - Phone:305-233-2010
Practice Address - Fax:305-233-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY04371103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8571Medicare PIN