Provider Demographics
NPI:1447922455
Name:SEGAL, MOLLY K
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:K
Last Name:SEGAL
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 1:9450 DOUBLOON DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-4560
Mailing Address - Country:US
Mailing Address - Phone:917-727-0380
Mailing Address - Fax:
Practice Address - Street 1:9450 DOUBLOON DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-4560
Practice Address - Country:US
Practice Address - Phone:407-797-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date: