MEDICARE: DEVEREUX

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	261QC1500X	Community Health Clinic/Center	160994624	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	:	1326301706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVEREUX

Provider Business Mailing Address
First Line	:	1010 EXECUTIVE CENTER DR
Second Line	:	SUITE 100
City	:	ORLANDO
State	:	FL
Zip	:	32803-3529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5850 T G LEE BLVD
Second Line	:	SUITE 400
City	:	ORLANDO
State	:	FL
Zip	:	32822-4407
Country	:	US
Telephone Number	:	321-281-3840
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JACQUITA ELSTON
Credential	:
Telephone Number	:	321-281-3840

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	06/20/2012

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Directions to “DEVEREUX ” Practice Location

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