Provider Demographics
NPI:1710002647
Name:MINTZ, DEVRA CARYN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DEVRA
Middle Name:CARYN
Last Name:MINTZ
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:17120 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2310
Mailing Address - Country:US
Mailing Address - Phone:954-349-2277
Mailing Address - Fax:954-446-6919
Practice Address - Street 1:17120 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2310
Practice Address - Country:US
Practice Address - Phone:954-349-2277
Practice Address - Fax:954-446-6919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-06-09
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Provider Licenses
StateLicense IDTaxonomies
FLME792432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry