Healthcare Provider Details

I. General information

NPI: 1205039617
Provider Name (Legal Business Name): EMILY C LUNDY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2896 EDGEHILL LN
HOLLYWOOD FL
33026-3773
US

IV. Provider business mailing address

2896 EDGEHILL LN
HOLLYWOOD FL
33026-3773
US

V. Phone/Fax

Practice location:
  • Phone: 954-296-3386
  • Fax:
Mailing address:
  • Phone: 954-296-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMA 44153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: