Provider Demographics
NPI:1437358322
Name:ACEVEDO, PAUL AUGUSTUS (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:AUGUSTUS
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 VILLAGE BLVD
Mailing Address - Street 2:SUITE 702
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1947
Mailing Address - Country:US
Mailing Address - Phone:561-882-6214
Mailing Address - Fax:561-882-6216
Practice Address - Street 1:901 VILLAGE BLVD
Practice Address - Street 2:SUITE 702
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1947
Practice Address - Country:US
Practice Address - Phone:561-882-6214
Practice Address - Fax:561-882-6216
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1056182084N0400X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001870000Medicaid
FLDC361AMedicare PIN