Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | 2015017599 | MO |
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME147809 | FL |
NPI | 1154702546 |
---|---|
Provider Name | Allyson Deziel |
First Address | North Palm Beach, FL 33408-2723 |
Second Address | Jupiter, FL 33458-4812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 25/06/2021 |