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General NPI Number Information
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NPI Number | 1952703878
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Entity Type | Organization
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Legal Business Name | SOUTHEAST PERINATAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVE STE 309
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City | MIRAMAR
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State | FL
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Zip | 33029-5614
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Country | US
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Telephone | 954-447-2704
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 CENTERVIEW DR STE 107
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City | RALEIGH
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State | NC
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Zip | 27606-3563
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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 | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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