Healthcare Provider Details

I. General information

NPI: 1790174563
Provider Name (Legal Business Name): MADILEY BROZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 590
HOLLYWOOD FL
33021-5468
US

IV. Provider business mailing address

1800 SW 85TH AVE
MIAMI FL
33155-1015
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-9500
  • Fax: 954-265-1431
Mailing address:
  • Phone: 305-469-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY-9219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: