Healthcare Provider Details

I. General information

NPI: 1730943614
Provider Name (Legal Business Name): SOUTH BEACH MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE OCEAN BLVD STE 200B
STUART FL
34996-3332
US

IV. Provider business mailing address

2100 SE OCEAN BLVD STE 200B
STUART FL
34996-3332
US

V. Phone/Fax

Practice location:
  • Phone: 772-252-5265
  • Fax: 772-874-3115
Mailing address:
  • Phone: 772-252-5265
  • Fax: 772-874-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEVINE N MAHMOUD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 772-874-3365