Provider Demographics
NPI:1376328336
Name:PROSPERE, BERVELYNN
Entity Type:Individual
Prefix:
First Name:BERVELYNN
Middle Name:
Last Name:PROSPERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 NW 24TH CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2114
Mailing Address - Country:US
Mailing Address - Phone:754-209-3993
Mailing Address - Fax:
Practice Address - Street 1:6620 NW 24TH CT
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2114
Practice Address - Country:US
Practice Address - Phone:754-209-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities