Healthcare Provider Details

I. General information

NPI: 1003609991
Provider Name (Legal Business Name): EZEQUIEL DISHMEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8391 W OAKLAND PARK BLVD
SUNRISE FL
33351-7307
US

IV. Provider business mailing address

8391 W OAKLAND PARK BLVD
SUNRISE FL
33351-7307
US

V. Phone/Fax

Practice location:
  • Phone: 954-335-6925
  • Fax: 954-400-3550
Mailing address:
  • Phone: 954-335-6925
  • Fax: 954-400-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11038839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: