MEDICARE: TODD DARMODY, MD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	9170276	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9170276	OTHER	FL	FLORIDA STATE

General Provider Information

NPI Number	:	1114347556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD DARMODY, MD, INC

Provider Business Mailing Address
First Line	:	6333 N FEDERAL HWY
Second Line	:	SUITE 285
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1907
Country	:	US
Telephone Number	:	954-712-1115
Fax Number	:	954-870-5467

Provider Business Practice Location Address
First Line	:	6333 N FEDERAL HWY
Second Line	:	SUITE 285
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1907
Country	:	US
Telephone Number	:	954-712-1115
Fax Number	:	954-870-5467

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JANICE FLECHA
Credential	:	MBA, CEC
Telephone Number	:	954-712-1115

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	04/24/2014

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