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General NPI Number Information
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NPI Number | 1053504845
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Entity Type | Individual
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Provider Name | JESSICA EVELSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 5550 GLADES RD STE 305-16
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City | BOCA RATON
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State | FL
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Zip | 33431-7205
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Country | US
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Telephone | 561-668-4525
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Fax | 561-437-8263
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Provider Business Mailing Address
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Address Line | 19156 SKYRIDGE CIR
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City | BOCA RATON
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State | FL
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Zip | 33498-6212
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Country | US
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Telephone | 347-658-4907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME 114713
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME 114713
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License Number State | FL
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