Healthcare Provider Details

I. General information

NPI: 1891719373
Provider Name (Legal Business Name): MONA DEVANESAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 45TH ST STE 110
WEST PALM BEACH FL
33407-2009
US

IV. Provider business mailing address

2151 45TH ST STE 110
WEST PALM BEACH FL
33407-2009
US

V. Phone/Fax

Practice location:
  • Phone: 561-863-4777
  • Fax: 561-863-0590
Mailing address:
  • Phone: 561-863-4777
  • Fax: 561-863-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME36051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: