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General NPI Number Information
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NPI Number | 1760902282
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Entity Type | Organization
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Legal Business Name | SPAAHMED LLC
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1820 NEJENSEN BEACH BLVD STE 561
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City | JENSEN BEACH
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State | FL
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Zip | 34957
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Country | US
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Telephone | 561-562-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 NEJENSEN BEACH BLVD STE 561
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City | JENSEN BEACH
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State | FL
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Zip | 34957-7212
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Country | US
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Telephone | 561-562-0268
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | DR. DONNAH FACEY
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Credential | MD
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Telephone | 561-562-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME126136
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License Number State | FL
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