Healthcare Provider Details

I. General information

NPI: 1528117611
Provider Name (Legal Business Name): BETHANEY REED VEJDANI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD SUITE 2030
MIAMI BEACH FL
33140-2800
US

IV. Provider business mailing address

4300 ALTON RD STE 2030
MIAMI BEACH FL
33140-2948
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-6770
  • Fax: 305-674-6704
Mailing address:
  • Phone: 305-674-6770
  • Fax: 305-674-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: