Provider Demographics
NPI:1053042333
Name:PEREZ, CHELSEY
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:PEREZ
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 1:21301 POWERLINE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2389
Mailing Address - Country:US
Mailing Address - Phone:866-550-2212
Mailing Address - Fax:561-516-7362
Practice Address - Street 1:21301 POWERLINE RD STE 106
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2389
Practice Address - Country:US
Practice Address - Phone:866-550-2212
Practice Address - Fax:561-516-7362
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1195996207R00000X
GA13273363A00000X
FLPA9116184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine