Provider Demographics
NPI:1912074188
Name:DEVEREAUX, DANIELLE C (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:C
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-2400
Mailing Address - Country:US
Mailing Address - Phone:321-255-9671
Mailing Address - Fax:
Practice Address - Street 1:1775 W HIBISCUS BLVD
Practice Address - Street 2:STE 215
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2620
Practice Address - Country:US
Practice Address - Phone:321-837-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD77713208000000X
FLME129224207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics