Provider Demographics
NPI:1710169909
Name:DELISA SKEETE HENRY PA
Entity Type:Organization
Organization Name:DELISA SKEETE HENRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DELISA
Authorized Official - Middle Name:SKEETE
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-581-8706
Mailing Address - Street 1:4100 S HOSPITAL DR
Mailing Address - Street 2:STE # 111
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2813
Mailing Address - Country:US
Mailing Address - Phone:954-581-8706
Mailing Address - Fax:954-581-8705
Practice Address - Street 1:4100 S HOSPITAL DR
Practice Address - Street 2:STE # 111
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2813
Practice Address - Country:US
Practice Address - Phone:954-581-8706
Practice Address - Fax:954-581-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85462207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76954Medicare UPIN
K8513Medicare PIN