Healthcare Provider Details

I. General information

NPI: 1457578148
Provider Name (Legal Business Name): REYNOLD SYLVESTER BRAITHWAITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/22/2011
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

3101 S OCEAN DR STE 2201
HOLLYWOOD FL
33019-2801
US

V. Phone/Fax

Practice location:
  • Phone: 305-895-5555
  • Fax: 305-947-0061
Mailing address:
  • Phone: 954-347-0070
  • Fax: 305-947-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME062140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: