Provider Demographics
NPI:1760948780
Name:CELLAMARE, HOLLY (PA-C, RT (R))
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:CELLAMARE
Suffix:
Gender:
Credentials:PA-C, RT (R)
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:CHRISTINE
Other - Last Name:SCHIEBL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1001 NW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2269
Mailing Address - Country:US
Mailing Address - Phone:561-955-6663
Mailing Address - Fax:
Practice Address - Street 1:745 MEADOWS RD STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2324
Practice Address - Country:US
Practice Address - Phone:561-955-6784
Practice Address - Fax:833-625-1611
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247100000X
NY5482392471C3402X
NY023890363A00000X
FLPA9118161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1760948780Medicaid