Healthcare Provider Details

I. General information

NPI: 1235691650
Provider Name (Legal Business Name): PAMELA VIEIRA LANE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD BLDG A
PIKEVILLE KY
41501-1602
US

IV. Provider business mailing address

5100 COCONUT CREEK PKWY
MARGATE FL
33063-3913
US

V. Phone/Fax

Practice location:
  • Phone: 606-430-3500
  • Fax: 606-218-4697
Mailing address:
  • Phone: 954-281-7700
  • Fax: 954-715-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTP924
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS17893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: