Healthcare Provider Details

I. General information

NPI: 1639790553
Provider Name (Legal Business Name): JOSHUA CHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 W STATE ROAD 84
DAVIE FL
33324-4202
US

IV. Provider business mailing address

10230 W STATE ROAD 84
DAVIE FL
33324-4202
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-6363
  • Fax: 954-217-6307
Mailing address:
  • Phone: 954-217-6363
  • Fax: 954-217-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number178833
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: