Healthcare Provider Details

I. General information

NPI: 1053227892
Provider Name (Legal Business Name): AMANDA DE LA CARIDAD MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 S STATE ROAD 7
DAVIE FL
33314-4647
US

IV. Provider business mailing address

9440 POINCIANA PL APT 209
DAVIE FL
33324-4862
US

V. Phone/Fax

Practice location:
  • Phone: 954-487-1663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI6871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: