Healthcare Provider Details

I. General information

NPI: 1033249180
Provider Name (Legal Business Name): JACQUELINE B PEVNY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S CONGRESS AVE
BOYNTON BEACH FL
33426-9012
US

IV. Provider business mailing address

2040 ALTA MEADOWS LN SUITE 1601
DELRAY BEACH FL
33444-1171
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-5600
  • Fax:
Mailing address:
  • Phone: 561-272-4888
  • Fax: 561-272-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE B PEVNY
Title or Position: OWNER
Credential: MD
Phone: 561-272-4888