Healthcare Provider Details

I. General information

NPI: 1457118580
Provider Name (Legal Business Name): NEW AGE MEDICAL AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 SW 106TH AVE STE A-109
CUTLER BAY FL
33157-7661
US

IV. Provider business mailing address

18901 SW 106TH AVE STE A-109
CUTLER BAY FL
33157-7661
US

V. Phone/Fax

Practice location:
  • Phone: 954-995-9176
  • Fax:
Mailing address:
  • Phone: 954-995-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAYRELIS BADA
Title or Position: FAMILY NURSE PRACTITIONER
Credential:
Phone: 954-995-9176