Healthcare Provider Details

I. General information

NPI: 1871601740
Provider Name (Legal Business Name): ALLISON MUIA WADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON DANIELLE MUIA M.D.

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S HARBOR CITY BLVD STE 101
MELBOURNE FL
32901-1901
US

IV. Provider business mailing address

930 S HARBOR CITY BLVD STE 101
MELBOURNE FL
32901-1901
US

V. Phone/Fax

Practice location:
  • Phone: 321-345-7579
  • Fax: 833-944-2173
Mailing address:
  • Phone: 321-345-7579
  • Fax: 833-944-2173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME106167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: