Healthcare Provider Details

I. General information

NPI: 1558324848
Provider Name (Legal Business Name): PEDIATRIC ENDOCRINE & DIABETES SPECAILISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BURNS RD SUITE 200
PALM BEACH GARDENS FL
33410-4325
US

IV. Provider business mailing address

3400 BURNS RD SUITE 200
PALM BEACH GARDENS FL
33410-4325
US

V. Phone/Fax

Practice location:
  • Phone: 561-624-1985
  • Fax: 561-624-7255
Mailing address:
  • Phone: 561-624-1985
  • Fax: 561-624-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME0056044
License Number StateFL

VIII. Authorized Official

Name: DR. MARY A. VACCARELLO-CRUZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-624-1985