Healthcare Provider Details

I. General information

NPI: 1710507199
Provider Name (Legal Business Name): MARISA AMANDA SEEGOBIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA AMANDA SEEGOBIN MD

II. Dates (important events)

Enumeration Date: 04/25/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 5000
WEST PALM BEACH FL
33401-3410
US

IV. Provider business mailing address

151 N NOB HILL RD STE 311
PLANTATION FL
33324-1708
US

V. Phone/Fax

Practice location:
  • Phone: 561-549-9090
  • Fax: 561-549-9091
Mailing address:
  • Phone: 561-549-9090
  • Fax: 561-549-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME173758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: