Healthcare Provider Details

I. General information

NPI: 1104002054
Provider Name (Legal Business Name): WAMBURA NEEMA MKONO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10075 S JOG RD STE 202
BOYNTON BEACH FL
33437-3536
US

IV. Provider business mailing address

6615 W. BOYNTON BEACH BLVD PMB 101
BOYNTON BEACH FL
33437-3536
US

V. Phone/Fax

Practice location:
  • Phone: 561-777-5308
  • Fax: 561-303-2131
Mailing address:
  • Phone: 561-777-5308
  • Fax: 561-303-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME110611
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME110611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: