Healthcare Provider Details

I. General information

NPI: 1336668763
Provider Name (Legal Business Name): MARIA NATALIE KYRIACOU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 SW 96TH ST STE 402
MIAMI FL
33196-1273
US

IV. Provider business mailing address

15955 SW 96TH ST
MIAMI FL
33196-1271
US

V. Phone/Fax

Practice location:
  • Phone: 786-467-3430
  • Fax:
Mailing address:
  • Phone: 786-467-3430
  • Fax: 786-533-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8587
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME141195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: