1285771386 NPI number — MRS. LISA DELANEY CAMHI RD MS LD/N

Table of content: MRS. LISA DELANEY CAMHI RD MS LD/N (NPI 1285771386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285771386 NPI number — MRS. LISA DELANEY CAMHI RD MS LD/N

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELANEY CAMHI
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD MS LD/N
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285771386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6678 NW 42ND WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33496-4041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-543-1044
Provider Business Mailing Address Fax Number:
561-807-6807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 NW CORPORATE BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-7337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-543-1044
Provider Business Practice Location Address Fax Number:
561-807-6807
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  ND3321 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E7121A . This is a "MEDICARE PART B ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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