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NPI Code Detail

MEDICARE: DR. EBONY PETIT M.D.

MEDICARE: DR. EBONY PETIT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician283643NY
22084P0800XPsychiatry Physician84043GA
32084P0800XPsychiatry Physician35.152412OH
42084P0800XPsychiatry Physician33936AL
52084P0800XPsychiatry PhysicianME137482FL

General Provider Information

NPI Number : 1447695184
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EBONY PETIT M.D.
Provider Business Mailing Address
First Line : 2054 VISTA PKWY STE 400
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33411-6742
Country : US
Telephone Number : 561-576-7879
Fax Number : 866-450-1704
Provider Business Practice Location Address
First Line : 2054 VISTA PKWY STE 400
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33411-6742
Country : US
Telephone Number : 561-576-7879
Fax Number : 866-450-1704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2013
Last Update Date : 05/29/2025

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