Healthcare Provider Details

I. General information

NPI: 1801469762
Provider Name (Legal Business Name): CHILDRENS MEDICAL ASSOCIATION PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SW 172ND AVE STE 200
MIRAMAR FL
33029-5613
US

IV. Provider business mailing address

8430 W BROWARD BLVD STE 300
PLANTATION FL
33324-2700
US

V. Phone/Fax

Practice location:
  • Phone: 954-722-0300
  • Fax: 954-722-4888
Mailing address:
  • Phone: 954-473-1011
  • Fax: 954-473-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA JOSEPH
Title or Position: ADMINISTRATIVE SUPERVISOR
Credential:
Phone: 954-473-1011