Healthcare Provider Details

I. General information

NPI: 1356765390
Provider Name (Legal Business Name): KATHRYN BONDI LIDDELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 04/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N FEDERAL HWY STE 370
POMPANO BEACH FL
33064-6550
US

IV. Provider business mailing address

4701 N FEDERAL HWY STE 370
POMPANO BEACH FL
33064-6550
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-5731
  • Fax: 954-941-2706
Mailing address:
  • Phone: 954-941-5731
  • Fax: 954-941-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9107764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: