Healthcare Provider Details

I. General information

NPI: 1710954672
Provider Name (Legal Business Name): SWALLOWING DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6093 NW 62ND TER
PARKLAND FL
33067-1538
US

IV. Provider business mailing address

6093 NW 62ND TER
PARKLAND FL
33067-1538
US

V. Phone/Fax

Practice location:
  • Phone: 954-578-4000
  • Fax: 954-578-4948
Mailing address:
  • Phone: 954-578-4000
  • Fax: 954-578-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. STACY L TARAKOFSKY
Title or Position: VICE PRESIDENT
Credential:
Phone: 954-578-4000