MEDICARE: NEDRA OBRADOVICH MA

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	324500000X	Substance Abuse Rehabilitation Facility		FL

General Provider Information

NPI Number	:	1487043774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEDRA OBRADOVICH MA

Provider Business Mailing Address
First Line	:	3402 FLORAL AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4926
Country	:	US
Telephone Number	:	561-236-5309
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 FLORAL AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4926
Country	:	US
Telephone Number	:	561-236-5309
Fax Number	:

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

Provider Enumeration Date	:	01/09/2015
Last Update Date	:	01/09/2015

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