Healthcare Provider Details

I. General information

NPI: 1326890989
Provider Name (Legal Business Name): ESTEVALY OBANDO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 S MILITARY TRL STE 208
DELRAY BEACH FL
33484-2654
US

IV. Provider business mailing address

14000 S MILITARY TRL STE 208
DELRAY BEACH FL
33484-2654
US

V. Phone/Fax

Practice location:
  • Phone: 239-690-6906
  • Fax:
Mailing address:
  • Phone: 305-773-5266
  • Fax: 561-563-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11032104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: