Healthcare Provider Details

I. General information

NPI: 1437021300
Provider Name (Legal Business Name): MARY MARGARET DEVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 35TH LANCE STE 100C
VERO BEACH FL
32960
US

IV. Provider business mailing address

18788 N VALLEY DR
FAIRVIEW PARK OH
44126-1761
US

V. Phone/Fax

Practice location:
  • Phone: 772-563-4741
  • Fax: 772-563-4646
Mailing address:
  • Phone: 216-633-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: