=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962709899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBERLY PARADOA DPM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2011
-----------------------------------------------------
Last Update Date | 02/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1627 US HIGHWAY 1 SUITE 208
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-3899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-589-9970
-----------------------------------------------------
Fax | 772-589-9939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3735 11TH CIR SUITE 201
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-299-7009
-----------------------------------------------------
Fax | 772-568-7138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AMBERLY C PARADOA
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 772-299-7009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | PO3105
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------