Healthcare Provider Details

I. General information

NPI: 1467802074
Provider Name (Legal Business Name): SK PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 N MILITARY TRL SUITE 102
PALM BEACH GARDENS FL
33410-5984
US

IV. Provider business mailing address

9121 N MILITARY TRL SUITE 102
PALM BEACH GARDENS FL
33410-5984
US

V. Phone/Fax

Practice location:
  • Phone: 561-619-2460
  • Fax: 561-828-9311
Mailing address:
  • Phone: 561-619-2460
  • Fax: 561-828-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LIZAIDA MEDINA CANDELARIA
Title or Position: OFFICE MANAGER
Credential: M.D.
Phone: 561-619-2460