MEDICARE: DR. NADEEN B MEDVIN PH.D.

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	103TC0700X	Clinical Psychologist	PY5624	FL

General Provider Information

NPI Number	:	1982985453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADEEN B MEDVIN PH.D.

Provider Business Mailing Address
First Line	:	1309 OBISPO AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3511
Country	:	US
Telephone Number	:	305-815-1129
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 S DIXIE HWY
Second Line	:	SUITE # 103
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-2456
Country	:	US
Telephone Number	:	305-815-1129
Fax Number	:

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

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	08/29/2011

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