Healthcare Provider Details

I. General information

NPI: 1689324162
Provider Name (Legal Business Name): DIRECT MEDICAL TO YOU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17519 CADENA DR
BOCA RATON FL
33496-1067
US

IV. Provider business mailing address

17519 CADENA DR
BOCA RATON FL
33496-1067
US

V. Phone/Fax

Practice location:
  • Phone: 845-729-5278
  • Fax: 845-362-8474
Mailing address:
  • Phone: 845-729-5278
  • Fax: 845-362-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOY SHULMAN
Title or Position: OWNER
Credential:
Phone: 845-729-5278