Healthcare Provider Details

I. General information

NPI: 1720932858
Provider Name (Legal Business Name): MOMMYMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19090 SKYRIDGE CIR
BOCA RATON FL
33498-6223
US

IV. Provider business mailing address

19090 SKYRIDGE CIR
BOCA RATON FL
33498-6223
US

V. Phone/Fax

Practice location:
  • Phone: 732-239-0399
  • Fax:
Mailing address:
  • Phone: 732-239-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARIELLA K KHAITOV
Title or Position: PHYSICIAN/CEO
Credential: MD
Phone: 732-239-0399