PEDIATRIC ENT LLC NPI 1508002072

NPI Information

NPI: 1508002072
Provider Name: PEDIATRIC ENT, LLC
Classification: Otolaryngology - 207YP0228X
Specialization: Pediatric Otolaryngology
Entity Type: Organization
Doing Business As: FAMILY ENT & AUDIOLOGY
Address: 1499 S HARBOR CITY BLVD STE 303
MELBOURNE, FL
ZIP 32901
Phone: (321) 254-5437

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NPI Details

PEDIATRIC ENT, LLC is a pediatric otolaryngology otolaryngology in Melbourne, FL. The provider is a pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing. PEDIATRIC ENT, LLC NPI is 1508002072. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Family Ent & Audiology.

The provider's business location address is:

1499 S HARBOR CITY BLVD STE 303
MELBOURNE, FL
ZIP 32901-245
Phone: (321) 254-5437
Fax: (321) 254-4543

The provider's authorized official is David Joel Malis .
The authorized official title is Manager and has the following contact phone number (321) 254-5437.

The enumeration date for this NPI number is 1/5/2009 and was last updated on 4/18/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207YP0228X	Otolaryngology	Pediatric Otolaryngology	ME90348	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01269821	OTHER	FLORIDA	MEDICAID HMO - AMERIGROUP
2	271247400	MEDICAID	FLORIDA
3	2258392	OTHER	FLORIDA	MEDICAID HMO - UNITED HEALTH CARE
4	332181	OTHER	FLORIDA	MEDICAID HMO - WELLCARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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