Provider Demographics
NPI:1982248225
Name:EMBREY, NICHELE
Entity Type:Individual
Prefix:
First Name:NICHELE
Middle Name:
Last Name:EMBREY
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 1:5156 SHALE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8749
Mailing Address - Country:US
Mailing Address - Phone:407-575-4587
Mailing Address - Fax:
Practice Address - Street 1:2111 MAJESTIC EAGLE PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-1915
Practice Address - Country:US
Practice Address - Phone:386-473-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician