Healthcare Provider Details

I. General information

NPI: 1508601501
Provider Name (Legal Business Name): DUDLEY ALEXIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13195 SW 134TH ST STE 201
MIAMI FL
33186-4585
US

IV. Provider business mailing address

1711 SW 65TH AVE
NORTH LAUDERDALE FL
33068-5235
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-6500
  • Fax:
Mailing address:
  • Phone: 305-345-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: