| Doctor Name: | MRS. JEREMY DALISAY CHAN |
| NPI Number: | 1346413804 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 6798 Ashburn Rd Lake Worth, FL - 334677319 |
| Business Phone Number: | 5616035389 |
| Business Fax Number: | |
| Mailing Address: | 6798 Ashburn Rd, LAKE WORTH |
| State: | FL |
| Postal Code: | 334677319 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/04/2008 |
| NPI Last Update Date: | 08/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |