Provider Demographics
NPI:1538464839
Name:DELRAY ADVANCED MEDICAL
Entity Type:Organization
Organization Name:DELRAY ADVANCED MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-330-6640
Mailing Address - Street 1:400 E LINTON BLVD
Mailing Address - Street 2:SUITE G5
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5082
Mailing Address - Country:US
Mailing Address - Phone:561-330-6640
Mailing Address - Fax:561-330-6642
Practice Address - Street 1:400 E LINTON BLVD
Practice Address - Street 2:SUITE G5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5082
Practice Address - Country:US
Practice Address - Phone:561-330-6640
Practice Address - Fax:561-330-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty