Provider Demographics
NPI:1659670446
Name:CLEGG, EVELYN ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:ELIZABETH
Last Name:CLEGG
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 1:4250 ALAFAYA TRL STE 212
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9424
Mailing Address - Country:US
Mailing Address - Phone:407-790-4007
Mailing Address - Fax:
Practice Address - Street 1:934 N MAGNOLIA AVE STE 327
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3840
Practice Address - Country:US
Practice Address - Phone:407-496-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-20
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator