Healthcare Provider Details

I. General information

NPI: 1114247004
Provider Name (Legal Business Name): ADAM VARADY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 08/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W HIBISCUS BLVD SUITE 215
MELBOURNE FL
32901-2620
US

IV. Provider business mailing address

1775 W HIBISCUS BLVD SUITE 215
MELBOURNE FL
32901-2620
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-9671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2013-02203
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME 123215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: