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General NPI Number Information
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NPI Number | 1952610461
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Entity Type | Individual
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Provider Name | AMY MIRIAM FORLEITER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 670 GLADES RD STE 220
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City | BOCA RATON
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State | FL
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Zip | 33431-6464
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Country | US
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Telephone | 561-394-6656
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Fax | 561-394-4022
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Provider Business Mailing Address
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Address Line | 2955 NW 126TH AVE UNIT 223-5
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City | SUNRISE
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State | FL
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Zip | 33323-6334
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Country | US
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Telephone | 781-254-7377
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 014892
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9109681
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License Number State | FL
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