Healthcare Provider Details

I. General information

NPI: 1003392358
Provider Name (Legal Business Name): DANIELLA ORTAL AZRAD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 KANE CONCOURSE STE 504
BAY HARBOR ISLANDS FL
33154-2043
US

IV. Provider business mailing address

1111 KANE CONCOURSE STE 504
BAY HARBOR ISLANDS FL
33154-2043
US

V. Phone/Fax

Practice location:
  • Phone: 645-215-2600
  • Fax: 645-215-3200
Mailing address:
  • Phone: 645-215-2600
  • Fax: 645-215-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110769
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020995-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: