MEDICARE: DR. GISELLE DEIROS MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	ME150225	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316434186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GISELLE DEIROS MD

Provider Business Mailing Address
First Line	:	5458 TOWN CENTER RD STE 20
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-1009
Country	:	US
Telephone Number	:	561-391-6210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 NW 54TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-2946
Country	:	US
Telephone Number	:	305-649-8871
Fax Number	:

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

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	01/17/2023

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