Provider Demographics
NPI:1447695184
Name:PETIT, EBONY (MD)
Entity type:Individual
Prefix:DR
First Name:EBONY
Middle Name:
Last Name:PETIT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 LAKE WORTH RD STE 213
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2966
Mailing Address - Country:US
Mailing Address - Phone:561-576-7879
Mailing Address - Fax:866-450-1704
Practice Address - Street 1:2054 VISTA PARKWAY
Practice Address - Street 2:SUITE 400 PMB 423
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:561-576-7879
Practice Address - Fax:866-450-1704
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1524122084P0800X
NY2836432084P0800X
GA840432084P0800X
AL339362084P0800X
FLME1374822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry