Healthcare Provider Details

I. General information

NPI: 1568404663
Provider Name (Legal Business Name): AUDREY LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 LINTON BLVD STE F107
DELRAY BEACH FL
33445-6506
US

IV. Provider business mailing address

4800 LINTON BLVD STE F107
DELRAY BEACH FL
33445-6506
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-5660
  • Fax: 561-498-0753
Mailing address:
  • Phone: 561-455-1337
  • Fax: 561-498-3579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCT043985
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME116636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: