=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700405537
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AYESSHA SUSANA SCHIFFINI PEREZ APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2020
-----------------------------------------------------
Last Update Date | 04/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17300 NE 23RD AVE
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-318-3654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17300 NE 23RD AVE
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-318-3654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11006715
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------