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General NPI Number Information
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NPI Number | 1952251738
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Entity Type | Individual
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Provider Name | EVELYNE CHARLES
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Gender | Female
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Dates
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Enumeration Date | 01/30/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 5523 NW DOWNS ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-4006
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Country | US
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Telephone | 772-240-6636
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Fax | 772-249-7002
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Provider Business Mailing Address
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Address Line | 5523 NW DOWNS ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-4006
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Country | US
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Telephone | 772-240-6636
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Fax | 772-249-7002
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 15-1698
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License Number State | FL
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