Healthcare Provider Details

I. General information

NPI: 1811306327
Provider Name (Legal Business Name): DEVONEAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 106
HIALEAH FL
33016-1813
US

IV. Provider business mailing address

7100 W 20TH AVE STE 106
HIALEAH FL
33016-1813
US

V. Phone/Fax

Practice location:
  • Phone: 754-581-6226
  • Fax: 305-246-0310
Mailing address:
  • Phone: 754-581-6226
  • Fax: 305-246-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1003085945
License Number StateFL

VIII. Authorized Official

Name: DEVON HARRINGTON
Title or Position: SUPERVISOR
Credential:
Phone: 305-247-0210