Healthcare Provider Details

I. General information

NPI: 1619557733
Provider Name (Legal Business Name): CHRISTIAN BRANDON DE ALLIE MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 S SEACREST BLVD STE 114
BOYNTON BEACH FL
33435-7531
US

IV. Provider business mailing address

1001 NW 13TH ST STE 201
BOCA RATON FL
33486-2269
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-4600
  • Fax: 833-625-1606
Mailing address:
  • Phone: 561-955-6663
  • Fax: 561-955-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME176603
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number41832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: