Healthcare Provider Details

I. General information

NPI: 1215638515
Provider Name (Legal Business Name): KATELYNE MARIE HERSTEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16215 S JOG RD STE 100
DELRAY BEACH FL
33446-2387
US

IV. Provider business mailing address

326 NORTHLAKE DR APT 201
NORTH PALM BEACH FL
33408-5244
US

V. Phone/Fax

Practice location:
  • Phone: 561-990-4857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number1407824097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: