MEDICARE: FLORIDA BAY ASSOCIATES LLC

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	2084P0800X	Psychiatry Physician	ME34257	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184863128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA BAY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	8201 SW 94TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-7303
Country	:	US
Telephone Number	:	305-457-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	8785 SW 165TH AVE
Second Line	:	SUITE #301
City	:	MIAMI
State	:	FL
Zip	:	33193-5826
Country	:	US
Telephone Number	:	305-457-9333
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL F MANDRI
Credential	:	MD
Telephone Number	:	305-457-9333

Provider Enumeration Date	:	02/15/2009
Last Update Date	:	04/25/2016

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