MEDICARE: IRIS DEVAUGHN

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	174400000X	Specialist

General Provider Information

NPI Number	:	1811509946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS DEVAUGHN

Provider Business Mailing Address
First Line	:	218 HIGH ST APT 6
Second Line	:
City	:	BURLINGTON CITY
State	:	NJ
Zip	:	08016-4420
Country	:	US
Telephone Number	:	856-203-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 HIGH ST APT 6
Second Line	:
City	:	BURLINGTON CITY
State	:	NJ
Zip	:	08016-4420
Country	:	US
Telephone Number	:	856-203-4747
Fax Number	:

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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Directions to “ IRIS DEVAUGHN ” Practice Location

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