Provider Demographics
NPI:1932512118
Name:NEPA, JUSTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:NEPA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4611 S UNIVERSITY DR STE 246
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-603-4081
Mailing Address - Fax:435-355-3710
Practice Address - Street 1:915 MIDDLE RIVER DR STE 103C
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3559
Practice Address - Country:US
Practice Address - Phone:954-603-4081
Practice Address - Fax:435-355-3710
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS149882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty