MEDICARE: DR. NANCY E DEJESUS 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	207Q00000X	Family Medicine Physician	ME 64301	FL
2	207Q00000X	Family Medicine Physician	188378	NY

General Provider Information

NPI Number	:	1215151634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY E DEJESUS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8256
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33482-8256
Country	:	US
Telephone Number	:	561-279-2722
Fax Number	:	561-279-2522

Provider Business Practice Location Address
First Line	:	900 E ATLANTIC AVE
Second Line	:	SUITE 9
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6954
Country	:	US
Telephone Number	:	561-279-2722
Fax Number	:	561-279-2522

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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