Healthcare Provider Details

I. General information

NPI: 1891616751
Provider Name (Legal Business Name): ANTHONY RALPH ANNUNZIATA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E OAKLAND PARK BLVD STE 205
FORT LAUDERDALE FL
33306-1658
US

IV. Provider business mailing address

499 EVERNIA ST APT 629
WEST PALM BEACH FL
33401-5468
US

V. Phone/Fax

Practice location:
  • Phone: 954-342-0982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: