MEDICARE: DENEIL FERGUSON

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1629443908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENEIL FERGUSON

Provider Business Mailing Address
First Line	:	4301 LIZSHIRE LN
Second Line	:	APT 306
City	:	ORLANDO
State	:	FL
Zip	:	32822-2242
Country	:	US
Telephone Number	:	631-704-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 LIZSHIRE LN
Second Line	:	APT 306
City	:	ORLANDO
State	:	FL
Zip	:	32822-2242
Country	:	US
Telephone Number	:	631-704-8580
Fax Number	:

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

Provider Enumeration Date	:	12/11/2015
Last Update Date	:	12/11/2015

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Directions to “ DENEIL FERGUSON ” Practice Location

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