Provider Demographics
NPI:1063435378
Name:SOVEL, DERRICK ALAN
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:ALAN
Last Name:SOVEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BROKEN SOUND PKWY NW
Mailing Address - Street 2:225
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3507
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-658-3992
Practice Address - Street 1:2435 US HIGHWAY 19
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3903
Practice Address - Country:US
Practice Address - Phone:727-939-2230
Practice Address - Fax:727-939-2245
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT22771OtherFLORIDA PROFESSIONAL LIC