Healthcare Provider Details

I. General information

NPI: 1285907329
Provider Name (Legal Business Name): AMITY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 SUNSET STRIP
SUNRISE FL
33313-6106
US

IV. Provider business mailing address

1060 SUNSET STRIP
SUNRISE FL
33313-6106
US

V. Phone/Fax

Practice location:
  • Phone: 954-224-5640
  • Fax: 954-473-0211
Mailing address:
  • Phone: 954-224-5640
  • Fax: 954-473-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FARID ASSOUAD
Title or Position: PRESIDENT
Credential: MD
Phone: 954-224-5640