Healthcare Provider Details

I. General information

NPI: 1073441598
Provider Name (Legal Business Name): MRS. IDEIDRE AMANDA MILORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 W CYPRESS CREEK RD STE 333
FORT LAUDERDALE FL
33309-1797
US

IV. Provider business mailing address

2950 W CYPRESS CREEK RD STE 333
FORT LAUDERDALE FL
33309-1797
US

V. Phone/Fax

Practice location:
  • Phone: 754-307-4748
  • Fax:
Mailing address:
  • Phone: 754-307-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: