Healthcare Provider Details

I. General information

NPI: 1598609497
Provider Name (Legal Business Name): ANNIE MAWUNA KORDAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 N PINE ISLAND RD
SUNRISE FL
33351-7349
US

IV. Provider business mailing address

3110 N PINE ISLAND RD APT 104
SUNRISE FL
33351-7302
US

V. Phone/Fax

Practice location:
  • Phone: 954-675-2151
  • Fax:
Mailing address:
  • Phone: 954-675-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: