Healthcare Provider Details

I. General information

NPI: 1457263246
Provider Name (Legal Business Name): VESA MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 CAMINO REAL STE 240
BOCA RATON FL
33433-5532
US

IV. Provider business mailing address

11315 FAIRFIELD ST
PARKLAND FL
33076-2870
US

V. Phone/Fax

Practice location:
  • Phone: 561-876-0969
  • Fax:
Mailing address:
  • Phone: 561-876-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEKSANDRA GREBENSHCHIKOVA
Title or Position: RN
Credential:
Phone: 786-543-5460