MEDICAL ASSOCIATES OF BREVARD LLC (NPI# 1376552349) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376552349 |
| Entity Type | Organization |
| Organization Name | MEDICAL ASSOCIATES OF BREVARD LLC |
| Other Organization Name | MEDICAL ASSOCIATES OF BREVARD, P.A. |
| Practice Address |
3021 W Eau Gallie Blvd Suite 101 Melbourne FL 32934 |
| Mailing Address |
Po Box 361015 Melbourne FL 32936-1015 |
| Practice Telephone | 3212550959 |
| Practice Fax Number | 3212550225 |
| Mailing Telephone | 3212550959 |
| Mailing Fax Number | 3212550225 |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2007-09-26 |
| Authorized Official Name | GERARD L. BESSETTE (ADMINISTRATOR) |
| Authorized Official Telephone | 3217289657 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDICAL ASSOCIATES OF BREVARD LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Medical Associates of Brevard, P.A. | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770821688 | Medical Associates of Brevard LLC | Clinic/Center | 6080 S. Babcock St. Se, Palm Bay, FL 32909-3921 | 2013-01-28 |
| 1639189251 | Medical Associates of Brevard LLC | Clinic/Center | 901 Jordan Blass Dr, Suite 103, Melbourne, FL 32940-1824 | 2006-08-08 |
| 1679582605 | Medical Associates of Brevard LLC | Clinic/Center | 580 N Wickham Rd, Suite A, Melbourne, FL 32935-8400 | 2006-08-07 |
| 1992128508 | Medical Associates of Brevard LLC | Clinic/Center | 2290 W Eau Gallie Blvd, Suite 110, Melbourne, FL 32935-3133 | 2014-02-03 |
| 1538582366 | Medical Associates of Brevard LLC | Clinic/Center | 575 S Wickham Rd, Suite A, West Melbourne, FL 32904-1170 | 2014-01-30 |
| 1639592561 | Medical Associates of Brevard LLC | Clinic/Center | 575 S Wickham Rd, Suite A, Melbourne, FL 32904-1170 | 2014-01-29 |
| 1942570098 | Medical Associates of Brevard LLC | Internal Medicine | 8045 Spyglass Hill Road, Suite 102, Melbourne, FL 32940-8567 | 2012-01-06 |
| 1053689810 | Medical Associates of Brevard LLC | Internal Medicine | 1301 W Eau Gallie Blvd Ste 108, Melbourne, FL 32935-5390 | 2011-12-08 |
| 1538476726 | Medical Associates of Brevard LLC | Obstetrics & Gynecology | 304 S Harbor City Blvd, Suite 101, Melbourne, FL 32901-1382 | 2010-09-09 |
| 1689987596 | Medical Associates of Brevard LLC | Internal Medicine | 397 N Wickham Rd, Suite 101, Melbourne, FL 32935-8669 | 2010-07-20 |
| Street Address |
3021 W EAU GALLIE BLVD SUITE 101 |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32934 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609867696 | Boris Havkin | Urology | 3021 W Eau Gallie Blvd, Melbourne, FL 32934-7005 | 2005-10-31 |
| 1679934996 | Boris Havkin Pllc | Urology | 3021 W Eau Gallie Blvd, Suite 103, Melbourne, FL 32934-7005 | 2016-03-14 |
| 1811007651 | Esmat Asham Gayed | Family Medicine | 3021 W Eau Gallie Blvd, Suite 101, Melbourne, FL 32934-7005 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013530419 | Ryan Thomas Kammerdener | Pharmacist | 3003 Bay Wind Ct, Melbourne, FL 32934 | 2020-05-20 |
| 1558833731 | Deborah J Gaffney | Specialist/Technologist | 3060 Kershaw Court, Melbourne, FL 32934 | 2018-12-27 |
| 1548703200 | Damaris Escarment | Counselor | 3550 W. Eau Gallie Blvd, Melbourne, FL 32934 | 2016-11-29 |
| 1447686324 | Sarai Escarment | Counselor | 3550 W Eau Gallie Blvd, Melbourne, FL 32934 | 2013-09-23 |
| 1871874974 | Felipe E. Dominguez, Md, Pa | Clinical Medical Laboratory | 3030 Venture Lane, Ste 108, Melbourne, FL 32934 | 2011-09-01 |
| 1376821637 | Christine Natasha Williams Kelly | Counselor | 4450 West Eau Gallie Blvd, Suite 200, Melbourne, FL 32934 | 2011-08-03 |
| 1912203316 | Sheryl Yatsko | Physical Therapy Assistant | 3303 Sarno Rd, Melbourne, FL 32934 | 2011-02-01 |
| 1255564191 | Joy Cheryl Mullen | Occupational Therapy Assistant | 1890 Whispering Oaks Cir, West Melbourne, FL 32934 | 2009-08-26 |
| 1619031531 | The Devereux Foundation | Case Management | 1591 Robert J Conlan Boulevard, Palm Bay, FL 32934 | 2006-12-22 |
| 1457456600 | Jo A Kologlu | Physical Therapist | 5025 Smithfield Rd, Melbourne, FL 32934 | 2006-09-13 |
| Find all providers in zip 32934 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821696766 | Advanced Healthcare Integration, LLC | Clinic/Center | 445 Pineda Ct Ste 200, Melbourne, FL 32940-7555 | 2020-10-13 |
| 1942792429 | Ethos Health Melbourne, LLC | Clinic/Center | 2755 N Wickham Rd Ste 102, Melbourne, FL 32935-2226 | 2018-05-31 |
| 1639189251 | Medical Associates of Brevard LLC | Clinic/Center | 901 Jordan Blass Dr, Suite 103, Melbourne, FL 32940-1824 | 2006-08-08 |
| 1679582605 | Medical Associates of Brevard LLC | Clinic/Center | 580 N Wickham Rd, Suite A, Melbourne, FL 32935-8400 | 2006-08-07 |
| 1649896804 | Tricoche Integrated Health Inc | Clinic/Center | 1855 W Hibiscus Blvd, Melbourne, FL 32901-2622 | 2020-06-23 |
| 1487270831 | Space Health LLC | Clinic/Center | 3800 W Eau Gallie Blvd Ste 101, Melbourne, FL 32934-3285 | 2020-06-22 |
| 1659841914 | Biocellular Therapies Inc | Clinic/Center | 2290 W Eau Gallie Blvd Ste 210b, Melbourne, FL 32935-3145 | 2018-11-29 |
| 1992128508 | Medical Associates of Brevard LLC | Clinic/Center | 2290 W Eau Gallie Blvd, Suite 110, Melbourne, FL 32935-3133 | 2014-02-03 |
| 1639592561 | Medical Associates of Brevard LLC | Clinic/Center | 575 S Wickham Rd, Suite A, Melbourne, FL 32904-1170 | 2014-01-29 |
| 1619104114 | Medical Associates of Brevard LLC | Clinic/Center | 2290 W Eau Gallie Blvd, Suite 202, Melbourne, FL 32935-3145 | 2009-06-11 |
| Find all providers in MELBOURNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.