MEDICARE: DR. JESSICA EVELSON M.D.

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	2084P0800X	Psychiatry Physician	ME 114713	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME 114713	FL

General Provider Information

NPI Number	:	1053504845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA EVELSON M.D.

Provider Business Mailing Address
First Line	:	19156 SKYRIDGE CIR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-6212
Country	:	US
Telephone Number	:	347-658-4907
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 GLADES RD STE 305-16
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-7205
Country	:	US
Telephone Number	:	561-668-4525
Fax Number	:	561-437-8263

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

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	01/27/2022

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