MEDICARE: SAJAE MACEDA FERNANDEZ

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	363LP2300X	Primary Care Nurse Practitioner	APRN11029563	FL

General Provider Information

NPI Number	:	1457193930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAJAE MACEDA FERNANDEZ

Provider Business Mailing Address
First Line	:	1840 SW 64TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1977
Country	:	US
Telephone Number	:	786-817-0187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 SW 64TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1977
Country	:	US
Telephone Number	:	786-817-0187
Fax Number	:

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/06/2024

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