Healthcare Provider Details

I. General information

NPI: 1396495180
Provider Name (Legal Business Name): FELICIA WATSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 420
MIAMI BEACH FL
33140-2849
US

IV. Provider business mailing address

PO BOX 630127
MIAMI FL
33163-0127
US

V. Phone/Fax

Practice location:
  • Phone: 305-672-1256
  • Fax:
Mailing address:
  • Phone: 305-672-1256
  • Fax: 305-672-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS21046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: