Healthcare Provider Details

I. General information

NPI: 1639127830
Provider Name (Legal Business Name): CAROLYN J AGRESTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N FLAGLER DR STE 600
WEST PALM BEACH FL
33401-3428
US

IV. Provider business mailing address

1411 N FLAGLER DR STE 9700
WEST PALM BEACH FL
33401-3422
US

V. Phone/Fax

Practice location:
  • Phone: 561-659-2266
  • Fax: 561-659-7846
Mailing address:
  • Phone: 561-899-3822
  • Fax: 561-899-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME69697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: