DR. MARY JUNE DERBENWICK (NPI# 1063405975) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063405975 |
| Entity Type | Individual |
| Full Name | DR. MARY JUNE DERBENWICK |
| Credential | M.D. |
| Practice Address |
350 N Clyde Morris Blvd Daytona Beach FL 32114-2733 |
| Mailing Address |
Po Box 9671 Daytona Beach FL 32120-9671 |
| Practice Telephone | 3862383244 |
| Practice Fax Number | 3862383269 |
| Mailing Telephone | 3866767130 |
| Mailing Fax Number | 3866767125 |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2016-02-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
ME0028487 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS | 64322 | 01 |
| FL | VHN | 1063405975 | 01 |
| FL | 264185200 | 05 | |
| FL | TRICARE | 1063405975 | 01 |
| FL | DCWO | ME0026487 | 01 |
| Street Address |
350 N CLYDE MORRIS BLVD |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-2733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205451705 | Tiffany Varela Khan | Nurse Practitioner | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2020-06-10 |
| 1245696301 | Andrea Likens | Dietitian, Registered | 350 N Clyde Morris Blvd, Suite 9, Daytona Beach, FL 32114-2733 | 2016-01-05 |
| 1245560291 | Cara J Karner | Dietetic Technician, Registered | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2010-01-13 |
| 1013189877 | Tyler Jay Staley | Physical Medicine & Rehabilitation | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2008-04-01 |
| 1083734784 | Mark A Miller | Pharmacist | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2007-03-29 |
| 1841322005 | Florida Health Care Plans Inc | Pharmacy | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2007-03-12 |
| 1730258088 | Richard Frank Miller | Nurse Practitioner | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2006-11-08 |
| 1154408904 | Joseph Michael Zobian | Ophthalmology | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2006-11-01 |
| 1518070119 | Niloufar Tabatabaei Wilson | Internal Medicine | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2795 | 2006-08-16 |
| 1851309629 | Stephen E Minor | Internal Medicine | 350 N Clyde Morris Blvd, Suite 1, Daytona Beach, FL 32114-2733 | 2006-08-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 2084V0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Vascular Neurology |
| Vascular Neurology is a subspecialty in the evaluation, prevention, treatment and recovery from vascular diseases of the nervous system. This subspecialty includes the diagnosis and treatment of vascular events of arterial or venous origin from a large number of causes that affect the brain or spinal cord such as ischemic stroke, intracranial hemorrhage, spinal cord ischemia and spinal cord hemorrhage. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376745935 | Madhu B Vijayappa | Psychiatry & Neurology | 8984 Sw 64th Ln, Gainesville, FL 32608-8562 | 2007-06-04 |
| 1194837708 | Sally B Zachariah | Psychiatry & Neurology | 10000 Bay Pines Blvd,neurology Section, Vamedical Center,bay Pines, Bay Pines, FL 33744 | 2006-08-31 |
| 1740258110 | Nils H. Mueller-kronast | Psychiatry & Neurology | 8756 Boynton Beach Blvd Ste 2300, Boynton Beach, FL 33472-4439 | 2006-03-10 |
| 1215475025 | Miami Stroke, LLC | Psychiatry & Neurology | 11750 Sw 40th St, Miami, FL 33175-3530 | 2017-02-01 |
| 1972918431 | David Stone | Psychiatry & Neurology | 1700 S Tamiami Trl, Sarasota, FL 34239-3509 | 2014-06-24 |
| 1972897023 | North Broward Hospital District | Psychiatry & Neurology | 201 E Sample Rd, Suite 106, Pompano Beach, FL 33064-3502 | 2011-06-07 |
| 1124337290 | Maxim Vladimirovich Mokin | Psychiatry & Neurology | 2 Tampa General Cir, 3rd Floor, Tampa, FL 33606-3603 | 2010-10-06 |
| 1144547134 | Muhammad Zeeshan Memon | Psychiatry & Neurology | 1611 Nw 12th Ave, Miami, FL 33136 | 2010-04-29 |
| 1497966394 | Ridwan Lin | Psychiatry & Neurology | 201 E Sample Rd, Pompano Beach, FL 33064-3502 | 2007-05-24 |
| 1366513467 | Akram Shhadeh | Psychiatry & Neurology | 1000 36th St, Vero Beach, FL 32960-4862 | 2006-11-11 |
| Find all providers with the same taxonomy | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.