Provider Demographics
NPI:1740669605
Name:LACEY, RACHELLE
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:600 VILLAGE SQUARE XING
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4543
Mailing Address - Country:US
Mailing Address - Phone:561-694-9493
Mailing Address - Fax:561-694-9064
Practice Address - Street 1:600 VILLAGE SQUARE XING
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4543
Practice Address - Country:US
Practice Address - Phone:561-694-9493
Practice Address - Fax:561-694-9064
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12916207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology