Provider Demographics
NPI:1821492141
Name:DEHAY, CHRISTAL (AP, DOM)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:
Last Name:DEHAY
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9532 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3416
Mailing Address - Country:US
Mailing Address - Phone:904-412-6168
Mailing Address - Fax:954-342-0224
Practice Address - Street 1:9532 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3416
Practice Address - Country:US
Practice Address - Phone:904-412-6168
Practice Address - Fax:954-342-0224
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist