Provider Demographics
NPI:1982914115
Name:MCCALLUM, CATHY HELEN
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:HELEN
Last Name:MCCALLUM
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 1:8525 100TH CT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-3365
Mailing Address - Country:US
Mailing Address - Phone:772-589-1957
Mailing Address - Fax:
Practice Address - Street 1:8525 100TH CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-3365
Practice Address - Country:US
Practice Address - Phone:772-589-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689007598Medicaid
FL689007596Medicaid