Healthcare Provider Details

I. General information

NPI: 1083477616
Provider Name (Legal Business Name): ANNA R ANTONY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 NW 107TH WAY APT 126
SUNRISE FL
33351-8110
US

IV. Provider business mailing address

3741 NW 107TH WAY APT 126
SUNRISE FL
33351-8110
US

V. Phone/Fax

Practice location:
  • Phone: 954-644-2160
  • Fax:
Mailing address:
  • Phone: 954-644-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29647
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: