Healthcare Provider Details

I. General information

NPI: 1457726416
Provider Name (Legal Business Name): DENETRA MONIQUE SAULSBY BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 FORUM PL SUITE #7
WEST PALM BEACH FL
33401-2330
US

IV. Provider business mailing address

1639 FORUM PL SUITE #7
WEST PALM BEACH FL
33401-2330
US

V. Phone/Fax

Practice location:
  • Phone: 561-712-8821
  • Fax: 561-712-8070
Mailing address:
  • Phone: 561-712-8821
  • Fax: 561-712-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberS421173797450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: