Healthcare Provider Details

I. General information

NPI: 1659832731
Provider Name (Legal Business Name): JULIENNE SEIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 NW 55TH AVE APT 307
LAUDERHILL FL
33313-3262
US

IV. Provider business mailing address

2111 NW 55TH AVE APT 307
LAUDERHILL FL
33313-3262
US

V. Phone/Fax

Practice location:
  • Phone: 754-422-7083
  • Fax:
Mailing address:
  • Phone: 754-422-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: JULIENNE SEIDE
Title or Position: MANAGER
Credential: CHAUFFEUR
Phone: 754-422-7083