MEDICARE: PRIORITY HEALTH MD INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1891447694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIORITY HEALTH MD INC

Provider Business Mailing Address
First Line	:	4765 SW 148TH AVE
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-2127
Country	:	US
Telephone Number	:	954-374-7545
Fax Number	:

Provider Business Practice Location Address
First Line	:	9999 SHERIDAN ST STE 120
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3086
Country	:	US
Telephone Number	:	954-589-1198
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ROBERTO FERNANDEZ-BLAY
Credential	:	MD
Telephone Number	:	954-890-2524

Provider Enumeration Date	:	01/23/2022
Last Update Date	:	12/13/2022

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Directions to “PRIORITY HEALTH MD INC ” Practice Location

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