Healthcare Provider Details

I. General information

NPI: 1295153070
Provider Name (Legal Business Name): FANEECE EMBRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 07/21/2022
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 EAST AVE
WEST PALM BEACH FL
33407-2387
US

IV. Provider business mailing address

5300 EAST AVE
WEST PALM BEACH FL
33407-2387
US

V. Phone/Fax

Practice location:
  • Phone: 561-227-5127
  • Fax: 561-455-9975
Mailing address:
  • Phone: 561-227-5127
  • Fax: 561-455-9975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME132060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: