Provider Demographics
NPI:1295836641
Name:SKEETE-HENRY, DELISA (MD)
Entity Type:Individual
Prefix:DR
First Name:DELISA
Middle Name:
Last Name:SKEETE-HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 S HOSPITAL DR
Mailing Address - Street 2:STE # 111
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2813
Mailing Address - Country:US
Mailing Address - Phone:954-581-8706
Mailing Address - Fax:954-581-8705
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:STE # 502
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-581-8706
Practice Address - Fax:954-581-8705
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85462207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265326500Medicaid
29015YMedicare Oscar/Certification
FLH76954Medicare UPIN