Provider Demographics
NPI:1831665314
Name:DALEMBERT, EVELYNE
Entity type:Individual
Prefix:MS
First Name:EVELYNE
Middle Name:
Last Name:DALEMBERT
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 1:8341 NW 74TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2736
Mailing Address - Country:US
Mailing Address - Phone:617-799-5325
Mailing Address - Fax:954-657-8702
Practice Address - Street 1:8341 NW 74TH ST
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2736
Practice Address - Country:US
Practice Address - Phone:617-799-5325
Practice Address - Fax:954-657-8702
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL023467100261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023467100Medicaid