Healthcare Provider Details

I. General information

NPI: 1285811232
Provider Name (Legal Business Name): NINOUTCHKA DEJEAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CLINT MOORE RD
BOCA RATON FL
33487-2768
US

IV. Provider business mailing address

1601 CLINT MOORE RD
BOCA RATON FL
33487-2768
US

V. Phone/Fax

Practice location:
  • Phone: 561-939-0520
  • Fax:
Mailing address:
  • Phone: 561-939-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME106271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: