Healthcare Provider Details

I. General information

NPI: 1023105715
Provider Name (Legal Business Name): MARIAN A LEVAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 BEACH BOULEVARD
JACKSONVILLE FL
32246
US

IV. Provider business mailing address

P.O. BOX 19249
JACKSONVILLE FL
32245-9249
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-9100
  • Fax: 904-642-9108
Mailing address:
  • Phone: 904-743-1883
  • Fax: 904-743-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME36086
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME36086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: