Healthcare Provider Details

I. General information

NPI: 1376014571
Provider Name (Legal Business Name): ONCOLOGY SPECIALISTS OF THE PALM BEACHES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE STE 105
ATLANTIS FL
33462-6636
US

IV. Provider business mailing address

5700 LAKE WORTH RD STE 204
GREENACRES FL
33463-3213
US

V. Phone/Fax

Practice location:
  • Phone: 561-740-0545
  • Fax: 561-740-0262
Mailing address:
  • Phone: 561-966-7707
  • Fax: 888-316-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY NALLEY
Title or Position: EHR ANALYST
Credential:
Phone: 561-966-7707