Provider Demographics
NPI:1629443908
Name:FERGUSON, DENEIL
Entity Type:Individual
Prefix:
First Name:DENEIL
Middle Name:
Last Name:FERGUSON
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 1:4301 LIZSHIRE LN
Mailing Address - Street 2:APT 306
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2242
Mailing Address - Country:US
Mailing Address - Phone:631-704-8580
Mailing Address - Fax:
Practice Address - Street 1:4301 LIZSHIRE LN
Practice Address - Street 2:APT 306
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2242
Practice Address - Country:US
Practice Address - Phone:631-704-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management