Healthcare Provider Details

I. General information

NPI: 1932475910
Provider Name (Legal Business Name): CHARLYN EMMANUEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 N STATE ROAD 7
MARGATE FL
33063-5777
US

IV. Provider business mailing address

1721 N STATE ROAD 7
MARGATE FL
33063-5777
US

V. Phone/Fax

Practice location:
  • Phone: 954-464-3227
  • Fax: 437-374-4130
Mailing address:
  • Phone: 954-464-3227
  • Fax: 437-374-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME123839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: