Healthcare Provider Details

I. General information

NPI: 1609873868
Provider Name (Legal Business Name): CHISARA ADONAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 12/09/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463646 SR 200 WEST SUITE 12
YULEE FL
12181-0742
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 904-775-3601
  • Fax: 904-849-1919
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number213701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: