MEDICARE: MAUDELINE DUNHAM

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11044537	FL

General Provider Information

NPI Number	:	1558227801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUDELINE DUNHAM

Provider Business Mailing Address
First Line	:	1250 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4634
Country	:	US
Telephone Number	:	954-451-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4634
Country	:	US
Telephone Number	:	954-451-1743
Fax Number	:

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

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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Directions to “ MAUDELINE DUNHAM ” Practice Location

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