Diabetic Shoe Source Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

NOT REQUIRED Issued in FL

Legal business name

DIABETIC SHOE SOURCE INC.

Practice address

156 S Charles Richard Beall Blvd
Suite 3
Debary, FL 32713-3273

Phone

(407) 323-5093

Fax

(407) 386-8074

NPI assigned

Mar 28, 2016

Last updated

Mar 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Anthony H Rivera, C. PED

Title

President

Phone

(407) 323-5093

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459123200000",
    "number": "1881056836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 S CHARLES RICHARD BEALL BLVD",
            "address_2": "SUITE 3",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327133273",
            "telephone_number": "407-323-5093",
            "fax_number": "407-386-8074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 S CHARLES RICHARD BEALL BLVD",
            "address_2": "SUITE 3",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327133273",
            "telephone_number": "407-323-5093",
            "fax_number": "407-386-8074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETIC SHOE SOURCE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-28",
        "last_updated": "2016-03-28",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-323-5093",
        "authorized_official_credential": "C. PED"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "NOT REQUIRED",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Edward Degrood, D.M.D.
• Nayadit Del Toro Benitez
• Delta Health Group Inc (DeBary Manor)
• Deltona Counseling Associates, P.a.
• Krista Denoff, RBT
• Jessica Diaz
• Joanne Elizabeth Dickerson
• Eileen Marie Dobrinski, LMHC
• Donna Stapleton
• Richard Allan Dowling, RN

• Durable Medical Equipment & Medical Supplies in Debary, FL
• Providers in Debary, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; 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.