Healthcare Provider Details

I. General information

NPI: 1083982649
Provider Name (Legal Business Name): WOMEN AND TEENS HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16876 NE 19TH AVE
NORTH MIAMI BEACH FL
33162-3108
US

IV. Provider business mailing address

16876 NE 19TH AVE
NORTH MIAMI BEACH FL
33162-3108
US

V. Phone/Fax

Practice location:
  • Phone: 305-895-5555
  • Fax: 305-947-0061
Mailing address:
  • Phone: 305-895-5555
  • Fax: 305-947-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME062140
License Number StateFL

VIII. Authorized Official

Name: DR. SYLVESTER BRAITHWAITE
Title or Position: MD
Credential:
Phone: 305-895-5555