Healthcare Provider Details

I. General information

NPI: 1053042333
Provider Name (Legal Business Name): CHELSEY PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 N CONGRESS AVE STE 107
WEST PALM BEACH FL
33407-3381
US

IV. Provider business mailing address

4601 N CONGRESS AVE STE 107
WEST PALM BEACH FL
33407-3381
US

V. Phone/Fax

Practice location:
  • Phone: 561-652-8650
  • Fax: 561-652-8651
Mailing address:
  • Phone: 561-652-8650
  • Fax: 561-652-8651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1195996
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13273
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: