Healthcare Provider Details

I. General information

NPI: 1497013908
Provider Name (Legal Business Name): HAVALEE HENRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 SUN N LAKE BLVD
SEBRING FL
33872-2170
US

IV. Provider business mailing address

4409 SUN N LAKE BLVD
SEBRING FL
33872-2170
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-3480
  • Fax:
Mailing address:
  • Phone: 863-402-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD15855
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME139593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: