Provider Demographics
NPI:1811662745
Name:DUVIVIER, JUNON SED
Entity type:Individual
Prefix:
First Name:JUNON
Middle Name:SED
Last Name:DUVIVIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4519
Mailing Address - Country:US
Mailing Address - Phone:347-552-7485
Mailing Address - Fax:
Practice Address - Street 1:10423 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4519
Practice Address - Country:US
Practice Address - Phone:347-552-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist