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General NPI Number Information
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NPI Number | 1184086696
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Entity Type | Individual
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Provider Name | STACEY ULLMAN VIAMONTE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-6970
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 NW 12TH AVE C-301
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-6970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | ME162138
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME162138
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License Number State | FL
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