Mailande Dedeaux, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9108878 Issued in FL

Practice address

400 Gulf Breeze Pkwy
Suite 300
Gulf Breeze, FL 32561-4458

Phone

(850) 932-5055

Fax

(850) 932-1404

NPI assigned

Sep 2, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mailande Parker Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Child Neurology Center of Northwest Florida PAGroup PAC ID 3870584345, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Child Neurology Center of Northwest Florida PA

  • General Practice Physician
  • Gulf Breeze, FL
  • NPI 1053392233
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1255708681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325620280",
            "telephone_number": "850-932-5055",
            "fax_number": "850-932-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GULF BREEZE PKWY",
            "address_2": "SUITE 300",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325614458",
            "telephone_number": "850-932-5055",
            "fax_number": "850-932-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDEAUX",
        "first_name": "MAILANDE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-02",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9108878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "JL0YB",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAILANDE",
            "last_name": "PARKER",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Suzanne Marie Day, O.D.
• Dean F Argentine, OD PA
• Deborah D. Viglione M.D., LLC
• Margaret Decarolis, NP
• Sheila Sue Decker, D.C.
• Bambi Defelice, ATC, LAT
• Diane C. Dejean, PT
• Mary Helen Del Mar, PMHNP-BC
• Delta Health Group Inc
• Michael Scott Demahy, PT

• Medical Physician Assistant in Gulf Breeze, FL
• Providers in Gulf Breeze, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.