Healthcare Provider Details

I. General information

NPI: 1770538662
Provider Name (Legal Business Name): BEENA WYCLIFFE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 BAPTIST WAY
HOMESTEAD FL
33033-7600
US

IV. Provider business mailing address

975 BAPTIST WAY
HOMESTEAD FL
33033-7600
US

V. Phone/Fax

Practice location:
  • Phone: 786-243-8000
  • Fax:
Mailing address:
  • Phone: 786-243-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA82400
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME168525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: