Healthcare Provider Details

I. General information

NPI: 1598601320
Provider Name (Legal Business Name): MARY ALEXA CHRISTODOULOU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

90 SW 3RD ST APT 2813
MIAMI FL
33130-4025
US

V. Phone/Fax

Practice location:
  • Phone: 732-841-1643
  • Fax:
Mailing address:
  • Phone: 732-841-1643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: