Individual
MS. DEREK ROYDAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1700 LUTHER LN STE 1170, PARK RIDGE, IL 60068-1270
(844) 376-3876
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(478) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1186126
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
09/15/2021
Last updated
03/09/2022
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