Healthcare Provider Details

I. General information

NPI: 1073441598
Provider Name (Legal Business Name): MRS. IDEIDRE AMANDA MILORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 NW 48TH LN
LAUDERHILL FL
33319-3427
US

IV. Provider business mailing address

5603 NW 48TH LN
LAUDERHILL FL
33319-3427
US

V. Phone/Fax

Practice location:
  • Phone: 305-397-5214
  • Fax:
Mailing address:
  • Phone: 305-397-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: