Healthcare Provider Details

I. General information

NPI: 1841110764
Provider Name (Legal Business Name): EMILY NICOLE CARDOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11285 SW 211TH ST
CUTLER BAY FL
33189-2211
US

IV. Provider business mailing address

14869 SW 178TH TER
MIAMI FL
33187-7707
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-5653
  • Fax:
Mailing address:
  • Phone: 786-359-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: