MEDICARE: MONA DEVANESAN M.D.

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	207VG0400X	Gynecology Physician	ME36051	FL

General Provider Information

NPI Number	:	1891719373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA DEVANESAN M.D.

Provider Business Mailing Address
First Line	:	2151 45TH ST STE 110
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2009
Country	:	US
Telephone Number	:	561-863-4777
Fax Number	:	561-863-0590

Provider Business Practice Location Address
First Line	:	2151 45TH ST STE 110
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2009
Country	:	US
Telephone Number	:	561-863-4777
Fax Number	:	561-863-0590

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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