Healthcare Provider Details

I. General information

NPI: 1225460983
Provider Name (Legal Business Name): SIVATHARSHINI JEYABALASINGAM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 GLADES RD
BOCA RATON FL
33434-3939
US

IV. Provider business mailing address

3504 COCO LAKE DR
COCONUT CREEK FL
33073-4145
US

V. Phone/Fax

Practice location:
  • Phone: 561-361-0500
  • Fax: 561-479-0384
Mailing address:
  • Phone: 954-655-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: