OrganizationActive
Pediatric Ent, LLC
NPI 1508002072 · Pediatric Otolaryngology Physician · Melbourne, FL
Provider details
- NPI number
- 1508002072
- Entity type
- Organization
- Primary specialty
- Pediatric Otolaryngology PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- David Malis, Manager
- License
- ME90348 (FL)
Practice location
1499 S Harbor City Blvd Ste 303
Melbourne, FL 32901-3245
Phone: (321) 254-5437
Fax: (321) 254-4543
Mailing address
1499 S Harbor City Blvd Ste 303
Melbourne, FL 32901-3245
Registry dates
- Enumerated
- 2009-01-05
- Last updated
- 2014-04-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.