Provider Demographics
NPI:1598490120
Name:VEDAEE, JALILEH MARIE (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JALILEH
Middle Name:MARIE
Last Name:VEDAEE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7210
Mailing Address - Country:US
Mailing Address - Phone:954-445-5425
Mailing Address - Fax:
Practice Address - Street 1:2800 S SEACREST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7966
Practice Address - Country:US
Practice Address - Phone:561-736-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020842363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care