MEDICARE: AMBER BRADDOCK

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	374J00000X	Doula		IL

General Provider Information

NPI Number	:	1265125173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER BRADDOCK

Provider Business Mailing Address
First Line	:	1000 BRICKELL AVE STE 715
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3047
Country	:	US
Telephone Number	:	786-387-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	17730 NW 14TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4630
Country	:	US
Telephone Number	:	786-387-1480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	05/29/2023

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Directions to “ AMBER BRADDOCK ” Practice Location

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