Maria E De Mora, D.A

Key facts

NPI

1407079700

Entity type

Individual (NPI type 1)

Primary specialty

Developmental Therapist 222Q00000X

Practice address

11722 Lynn Brook Cir
Seffner, FL 33584-7203

Phone

(813) 484-2314

Fax

(813) 433-5163

NPI assigned

Apr 11, 2007

Sex

Female

Sole proprietor

Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childrens Development First. Corp Early Intervention Provider Agency · Seffner, FL · NPI 1013566017
  NPD
• Supporting Bright Stars, LLC Early Intervention Provider Agency · Brandon, FL · NPI 1316187032
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 20, 2019.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568937600000",
    "number": "1407079700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11722 LYNN BROOK CIR",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335847203",
            "telephone_number": "813-484-2314",
            "fax_number": "813-433-5163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11722 LYNN BROOK CIR",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335847203",
            "telephone_number": "813-484-2314",
            "fax_number": "813-433-5163"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "708 Pearl Cir",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "335104246",
            "country_code": "US",
            "telephone_number": "813-391-0235",
            "fax_number": "813-655-4814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE MORA",
        "first_name": "MARIA",
        "middle_name": "E",
        "credential": "D.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2019-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "811584200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Seffner, FL · Developmental Therapist in Florida