Healthcare Provider Details

I. General information

NPI: 1518742535
Provider Name (Legal Business Name): BEDAS MEDICAL AND WELLNESS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 214
HIALEAH FL
33016-1812
US

IV. Provider business mailing address

4137 SW 195TH TER
MIRAMAR FL
33029-2749
US

V. Phone/Fax

Practice location:
  • Phone: 786-359-4852
  • Fax:
Mailing address:
  • Phone: 215-531-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PERPETUA NNEKA EZEH-AIDEYAN
Title or Position: PROVIDER/OWNER
Credential: MD
Phone: 215-531-2848