Healthcare Provider Details

I. General information

NPI: 1134826357
Provider Name (Legal Business Name): PROSPECT HEALTH SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 N STATE ROAD 7 STE 219
FORT LAUDERDALE FL
33319-2969
US

IV. Provider business mailing address

5460 N STATE ROAD 7 STE 219
FORT LAUDERDALE FL
33319-2969
US

V. Phone/Fax

Practice location:
  • Phone: 888-596-0290
  • Fax:
Mailing address:
  • Phone: 888-596-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHAUDHRY SHABBIR AHMED JR.
Title or Position: OWNER
Credential:
Phone: 336-587-3223