Healthcare Provider Details

I. General information

NPI: 1962886788
Provider Name (Legal Business Name): ESTEBAN CARDONNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 S RED RD STE 611
SOUTH MIAMI FL
33143-3649
US

IV. Provider business mailing address

6705 S RED RD STE 611
SOUTH MIAMI FL
33143-3649
US

V. Phone/Fax

Practice location:
  • Phone: 305-202-4768
  • Fax: 916-249-0695
Mailing address:
  • Phone: 305-202-4768
  • Fax: 916-249-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME151889
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME151889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: