Healthcare Provider Details

I. General information

NPI: 1174965743
Provider Name (Legal Business Name): MIGUEL A NERYS-CHAHIN M.S., NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SE 5TH AVE
DELRAY BEACH FL
33483-5211
US

IV. Provider business mailing address

440 SE 5TH AVE
DELRAY BEACH FL
33483-5211
US

V. Phone/Fax

Practice location:
  • Phone: 561-755-7179
  • Fax:
Mailing address:
  • Phone: 561-755-7179
  • Fax: 954-497-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH9550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: