Healthcare Provider Details

I. General information

NPI: 1366034761
Provider Name (Legal Business Name): BIANCA N FAZIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 W 24TH AVE STE 9
HIALEAH FL
33016-5596
US

IV. Provider business mailing address

8051 W 24TH AVE STE 9
HIALEAH FL
33016-5596
US

V. Phone/Fax

Practice location:
  • Phone: 305-400-9702
  • Fax:
Mailing address:
  • Phone: 305-400-9702
  • Fax: 305-735-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9113960
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113960
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: