Healthcare Provider Details

I. General information

NPI: 1396676672
Provider Name (Legal Business Name): AMIDALA CARE REGISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6919 SW 18TH ST STE C221
BOCA RATON FL
33433-7010
US

IV. Provider business mailing address

6919 SW 18TH ST STE C221
BOCA RATON FL
33433-7010
US

V. Phone/Fax

Practice location:
  • Phone: 786-316-7568
  • Fax: 561-258-6470
Mailing address:
  • Phone:
  • Fax: 561-258-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DAYANA MATO SALABARRIA
Title or Position: PST
Credential:
Phone: 786-316-7568