Healthcare Provider Details

I. General information

NPI: 1447518592
Provider Name (Legal Business Name): MONA AMIN D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 S FEDERAL HWY
FT LAUDERDALE FL
33316-1245
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 954-315-5784
  • Fax: 954-522-0755
Mailing address:
  • Phone: 954-962-9022
  • Fax: 954-966-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number279339-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS14518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: