Healthcare Provider Details

I. General information

NPI: 1104399435
Provider Name (Legal Business Name): VENITA AUGUSTE-DUVERSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 LAWN AVE
SELLERSVILLE PA
18960-1549
US

IV. Provider business mailing address

PO BOX 32
SELLERSVILLE PA
18960-0032
US

V. Phone/Fax

Practice location:
  • Phone: 215-257-6551
  • Fax: 215-257-6570
Mailing address:
  • Phone: 215-257-6551
  • Fax: 215-257-6570

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: