MEDICARE: DAWN M SEPULVEDA ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	651061541	FL

General Provider Information

NPI Number	:	1013430701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN M SEPULVEDA ARNP

Provider Business Mailing Address
First Line	:	10151 ENTERPRISE CTR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3759
Country	:	US
Telephone Number	:	561-734-7400
Fax Number	:	561-734-7448

Provider Business Practice Location Address
First Line	:	10151 ENTERPRISE CTR STE 106
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3760
Country	:	US
Telephone Number	:	561-734-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	07/25/2017

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