Healthcare Provider Details

I. General information

NPI: 1174556260
Provider Name (Legal Business Name): SORAYA BREDA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 LINTON BLVD STE 203
DELRAY BEACH FL
33484-6567
US

IV. Provider business mailing address

5162 LINTON BLVD STE 203
DELRAY BEACH FL
33484-6567
US

V. Phone/Fax

Practice location:
  • Phone: 561-877-3376
  • Fax: 877-992-1153
Mailing address:
  • Phone: 561-877-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: