Provider Demographics
NPI:1639127830
Name:AGRESTI, CAROLYN J (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:AGRESTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N FLAGLER DR STE 9700
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3422
Mailing Address - Country:US
Mailing Address - Phone:561-899-3822
Mailing Address - Fax:561-899-3859
Practice Address - Street 1:1515 N FLAGLER DR
Practice Address - Street 2:STE 600
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3428
Practice Address - Country:US
Practice Address - Phone:561-659-2266
Practice Address - Fax:561-659-7846
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69697207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379496200Medicaid
28334Medicare ID - Type Unspecified
FL379496200Medicaid