Healthcare Provider Details

I. General information

NPI: 1669780656
Provider Name (Legal Business Name): AMANDA RUTH ALLADIN MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE PEDIATRIC DEPARTMENT
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6042
  • Fax:
Mailing address:
  • Phone: 305-585-7456
  • Fax: 305-585-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberME116535
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME116535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: