Healthcare Provider Details

I. General information

NPI: 1811971799
Provider Name (Legal Business Name): THANIA VALLEDOR QUESADA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 TOWN CENTER CIRCLE #204
WESTON FL
33326
US

IV. Provider business mailing address

13878 SW 43RD ST
DAVIE FL
33330-5742
US

V. Phone/Fax

Practice location:
  • Phone: 954-385-0055
  • Fax: 954-231-0416
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME63999
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME63999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: