=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245392943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACD PEDIATRIC GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2006
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3416 W 84TH STREET SUITE 100
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-4933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-826-9449
-----------------------------------------------------
Fax | 305-828-1255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3416 W 84TH STREET SUITE 100
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-4933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-826-9449
-----------------------------------------------------
Fax | 305-828-1255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | EVELYN ANEIDA DELGADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-826-9449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083B0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2080B0002X
-----------------------------------------------------
Taxonomy Name | Pediatric Obesity Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------