MEDICARE: PREVALUS ENTERPRISE LLC

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	:	1700722857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVALUS ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	3938 W SANDPIPER DR APT 2
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-2476
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3938 W SANDPIPER DR APT 2
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-2476
Country	:	US
Telephone Number	:	561-644-2261
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JUNIOR PREVALUS
Credential	:
Telephone Number	:	561-644-2261

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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