Provider Demographics
NPI:1518708965
Name:MARCELUS, ANTOINE
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:MARCELUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2046
Mailing Address - Country:US
Mailing Address - Phone:561-584-2864
Mailing Address - Fax:
Practice Address - Street 1:536 WALKER AVE
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2046
Practice Address - Country:US
Practice Address - Phone:561-584-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services