Healthcare Provider Details

I. General information

NPI: 1942809959
Provider Name (Legal Business Name): STEPHANIE AMORTEGUI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14125 NW 80TH AVE
MIAMI LAKES FL
33016-2350
US

IV. Provider business mailing address

18256 NW 6TH ST
PEMBROKE PINES FL
33029-3676
US

V. Phone/Fax

Practice location:
  • Phone: 305-306-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9113515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: