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General NPI Number Information
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NPI Number | 1184435604
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Entity Type | Individual
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Provider Name | MICHELLE SOUTHBY
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 8900 N KENDALL DR
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City | MIAMI
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State | FL
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Zip | 33176-2118
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Country | US
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Telephone | 786-397-9470
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Fax |
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Provider Business Mailing Address
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Address Line | 11899 SW 74TH TER
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City | MIAMI
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State | FL
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Zip | 33183-3715
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Country | US
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Telephone |
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA1036
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License Number State | FL
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