Provider Demographics
NPI:1891719373
Name:DEVANESAN, MONA (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:DEVANESAN
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 1:2151 45TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2009
Mailing Address - Country:US
Mailing Address - Phone:561-863-4777
Mailing Address - Fax:561-863-0590
Practice Address - Street 1:2151 45TH ST STE 110
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2009
Practice Address - Country:US
Practice Address - Phone:561-863-4777
Practice Address - Fax:561-863-0590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36051207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD62029Medicare UPIN