Healthcare Provider Details

I. General information

NPI: 1841762689
Provider Name (Legal Business Name): MRS. LISSETTE CARMEN MENNECHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5931
US

IV. Provider business mailing address

1414 S JEAGA DR
JUPITER FL
33458-8769
US

V. Phone/Fax

Practice location:
  • Phone: 561-616-8411
  • Fax: 561-616-8412
Mailing address:
  • Phone: 614-813-5308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: