MEDICARE: DINAH PICKETT

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	253Z00000X	In Home Supportive Care Agency	299994233	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P230-170-61-509-0	OTHER	FL	HOME CARE

General Provider Information

NPI Number	:	1598373300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINAH PICKETT

Provider Business Mailing Address
First Line	:	2640 HOLLYWOOD BLVD STE 101
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4830
Country	:	US
Telephone Number	:	954-505-7957
Fax Number	:	954-744-7408

Provider Business Practice Location Address
First Line	:	2640 HOLLYWOOD BLVD STE 101
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4830
Country	:	US
Telephone Number	:	954-505-7957
Fax Number	:	954-744-7408

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

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	07/17/2020

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Directions to “ DINAH PICKETT ” Practice Location

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