Provider Demographics
NPI:1053727735
Name:DEVAUX, MIKAELA (MD)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:DEVAUX
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 1:1414 KUHL AVE # MP31
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:407-237-6329
Practice Address - Fax:407-649-3083
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130853204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine