Provider Demographics
NPI:1366102196
Name:FENTY-MARSEIL, EVALEE P
Entity type:Individual
Prefix:MRS
First Name:EVALEE
Middle Name:P
Last Name:FENTY-MARSEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13173 DON LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-7910
Mailing Address - Country:US
Mailing Address - Phone:352-403-9771
Mailing Address - Fax:
Practice Address - Street 1:13173 DON LOOP
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-7910
Practice Address - Country:US
Practice Address - Phone:352-403-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-204114106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician