Healthcare Provider Details

I. General information

NPI: 1023468600
Provider Name (Legal Business Name): FLETA BRAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 10TH AVE # 2023A
MIAMI FL
33136-1015
US

IV. Provider business mailing address

1600 NW 10TH AVE # 2023A
MIAMI FL
33136-1015
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4472
  • Fax:
Mailing address:
  • Phone: 305-243-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN23519
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME149784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: