Doctor Name: | DR. SHALEENE PERSAUD-VASQUEZ |
NPI Number: | 1265897904 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | ACN719 |
Business Practice Address: | 6405 W Indiantown Rd Ste B Jupiter, FL - 334584040 |
Business Phone Number: | 5612037511 |
Business Fax Number: | |
Mailing Address: | 5406 Rivermill Ln, LAKE WORTH |
State: | FL |
Postal Code: | 334637439 |
Phone Number: | 5617587933 |
Fax Number: | |
NPI Enumeration Date: | 12/23/2015 |
NPI Last Update Date: | 12/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ACN719 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |