Healthcare Provider Details

I. General information

NPI: 1649550591
Provider Name (Legal Business Name): CHERISE MIZRAHI-LEVI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 NE 26TH ST
WILTON MANORS FL
33305-1536
US

IV. Provider business mailing address

2140 NE 26TH ST
WILTON MANORS FL
33305-1536
US

V. Phone/Fax

Practice location:
  • Phone: 347-733-8652
  • Fax:
Mailing address:
  • Phone: 347-733-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number265487
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS16512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: