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General NPI Number Information
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NPI Number | 1528367711
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Entity Type | Organization
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Legal Business Name | DELRAY ADVANCED MEDICAL GROUP LLC
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 30 SE 6TH ST
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City | BOCA RATON
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State | FL
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Zip | 33432-6016
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Country | US
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Telephone | 561-948-1915
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Fax | 561-344-6822
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Provider Business Mailing Address
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Address Line | 30 SE 6TH ST
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City | BOCA RATON
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State | FL
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Zip | 33432-6016
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Country | US
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Telephone | 561-948-1915
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Fax | 561-344-6822
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Authorized Official
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Title or Position | MANAGER
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Name | MS. SALLY BERRY
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Credential |
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Telephone | 561-330-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME48746
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License Number State | FL
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