Healthcare Provider Details

I. General information

NPI: 1891478848
Provider Name (Legal Business Name): CHARESSAH MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12545 ORANGE DR STE 502
DAVIE FL
33330-4306
US

IV. Provider business mailing address

4027 CASCADA CIR
HOLLYWOOD FL
33024-8517
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-8048
  • Fax: 954-474-8145
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: