Provider Demographics
NPI:1962150219
Name:DELIARD, MARTINE
Entity type:Individual
Prefix:MRS
First Name:MARTINE
Middle Name:
Last Name:DELIARD
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 1:1501 NW 108TH AVE APT 338
Mailing Address - Street 2:APT 338
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6906
Mailing Address - Country:US
Mailing Address - Phone:954-638-0158
Mailing Address - Fax:
Practice Address - Street 1:1501 NW 108TH AVE
Practice Address - Street 2:APT 338
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322
Practice Address - Country:US
Practice Address - Phone:954-638-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252Y00000XMedicaid