Healthcare Provider Details

I. General information

NPI: 1790547271
Provider Name (Legal Business Name): DEMENTIA CARE FL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 MERIDIAN AVE STE 716
MIAMI BEACH FL
33139-2710
US

IV. Provider business mailing address

1032 E BRANDON BLVD # 7437
BRANDON FL
33511-5509
US

V. Phone/Fax

Practice location:
  • Phone: 407-519-3098
  • Fax: 407-497-7020
Mailing address:
  • Phone: 407-690-6254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN AMOS
Title or Position: ADMIN
Credential:
Phone: 646-406-9347