Healthcare Provider Details

I. General information

NPI: 1922097047
Provider Name (Legal Business Name): CHILDRENS HEMATOLOGY & ONCOLOGY ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 GREENWOOD AVE #306
WEST PALM BEACH FL
33407-2452
US

IV. Provider business mailing address

5325 GREENWOOD AVE #306
WEST PALM BEACH FL
33407-2452
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-6363
  • Fax: 561-844-6391
Mailing address:
  • Phone: 561-844-6363
  • Fax: 561-844-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME51289
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800004117
License Number StateFL

VIII. Authorized Official

Name: MRS. PAMELA SUE STUMBO-OSHEA
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-844-6363