Healthcare Provider Details

I. General information

NPI: 1760997571
Provider Name (Legal Business Name): BROWARD ONCOLOGY AND SICKLE CELL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SE 4TH AVE STE J
FT LAUDERDALE FL
33316-1958
US

IV. Provider business mailing address

5324 SW 34TH WAY
FT LAUDERDALE FL
33312-5545
US

V. Phone/Fax

Practice location:
  • Phone: 954-623-7299
  • Fax: 954-525-3033
Mailing address:
  • Phone: 954-623-7299
  • Fax: 954-525-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME97695
License Number StateFL

VIII. Authorized Official

Name: ARCHANA MAINI
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 954-623-7299