Delmar Glen Pack PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY6914 Issued in FL

Legal business name

DELMAR GLEN PACK PA

Practice address

810 Briarwood CT
Orange City, FL 32763-4319

Phone

(386) 956-1689

NPI assigned

Mar 2, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Corinne Zimmerman

Title

Enrollment Specialist

Phone

(954) 366-2700

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488412800000",
    "number": "1609316272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 BRIARWOOD CT",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327634319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 BRIARWOOD CT",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327634319",
            "telephone_number": "386-956-1689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELMAR GLEN PACK PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-02",
        "last_updated": "2017-03-02",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "CORINNE",
        "authorized_official_title_or_position": "ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "954-366-2700"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY6914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sally Ong Dee, MD
• Sandra O Dee, MD
• Gennifer Elizabeth Dekalands, PTA
• Lalaine Dela Cruz, ARNP
• Brittany L Dellechiaie, APRN
• Deltona Medical Arts Pharmacy Inc
• Deltona Medical Center LLC
• Deltona Medical Center LLC
• Deltona Wellness & Psychiatry Clinic PLLC
• David Demetree, PA-C

• Psychologist in Orange City, FL
• Providers in Orange City, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.