MEDICARE: SECRETLY YOURS ENT INC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1144357856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECRETLY YOURS ENT INC

Provider Business Mailing Address
First Line	:	9121 N MILITARY TRAIL SUITE 105
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410
Country	:	US
Telephone Number	:	561-694-5970
Fax Number	:	561-694-5972

Provider Business Practice Location Address
First Line	:	9121 N MILITARY TRL STE 105
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-5985
Country	:	US
Telephone Number	:	561-694-5970
Fax Number	:	561-694-5972

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JODI L DAVIS
Credential	:
Telephone Number	:	561-694-5970

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	06/07/2024

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