MEDICARE: BELFON HEALTH AND AESTHETICS

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	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356911770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELFON HEALTH AND AESTHETICS

Provider Business Mailing Address
First Line	:	1861 SW 101ST WAY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6531
Country	:	US
Telephone Number	:	786-412-1150
Fax Number	:	478-202-9585

Provider Business Practice Location Address
First Line	:	12064 MIRAMAR PKWY STE 101
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-7003
Country	:	US
Telephone Number	:	786-412-1150
Fax Number	:

Authorized Official
Title or Position	:	OWNER, NURSE PRACTITIONER
Name	:	MRS. TYSHARRA KENYATTA BELFON
Credential	:	NP
Telephone Number	:	786-412-1150

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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