Provider Demographics
NPI:1720345226
Name:COMEAU, DIVYA MARIE (AP, DOM)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:MARIE
Last Name:COMEAU
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:COMEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 CRAWFORD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3777
Mailing Address - Country:US
Mailing Address - Phone:561-703-7830
Mailing Address - Fax:
Practice Address - Street 1:301 CRAWFORD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3777
Practice Address - Country:US
Practice Address - Phone:561-703-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2971171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist