MEDICARE: SORAYA BREDA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9102225	FL

General Provider Information

NPI Number	:	1174556260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SORAYA BREDA PA-C

Provider Business Mailing Address
First Line	:	5162 LINTON BLVD STE 203
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6567
Country	:	US
Telephone Number	:	561-877-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	5162 LINTON BLVD STE 203
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6567
Country	:	US
Telephone Number	:	561-877-3376
Fax Number	:	877-992-1153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/03/2019

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