Healthcare Provider Details

I. General information

NPI: 1477318079
Provider Name (Legal Business Name): MORIAH LIEBERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 N BELCHER RD STE D2
CLEARWATER FL
33765-1450
US

IV. Provider business mailing address

1701 HIGHWAY A1A STE 300
VERO BEACH FL
32963-2263
US

V. Phone/Fax

Practice location:
  • Phone: 727-734-6631
  • Fax: 727-736-0548
Mailing address:
  • Phone: 561-320-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: