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General NPI Number Information
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NPI Number | 1053963207
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Entity Type | Organization
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Legal Business Name | THE RAVE CLINIC, LLC
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 2767 S STATE ROAD 7
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City | WELLINGTON
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State | FL
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Zip | 33414-9320
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Country | US
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Telephone | 274-743-5428
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Fax |
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Provider Business Mailing Address
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Address Line | 2767 S STATE ROAD 7
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City | WELLINGTON
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State | FL
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Zip | 33414-9320
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Country | US
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Telephone | 274-743-5428
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Fax |
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | DR. DENIL SHEKHAT
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Credential | MD
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Telephone | 865-274-0102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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