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General NPI Number Information
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NPI Number | 1588250948
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Entity Type | Organization
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Legal Business Name | AGE DEFYING EXPERTS SOUTH FLORIDA LLC
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 5379 LYONS RD # 1599
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2810
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Country | US
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Telephone | 786-505-4423
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Fax |
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Provider Business Mailing Address
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Address Line | 5379 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2810
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Country | US
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Telephone | 786-505-4423
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DANIELA CHETAN
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Credential | APRN
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Telephone | 786-505-4423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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