MEDICARE: ROSALYN MISDRAJI OD RN

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	163W00000X	Registered Nurse	RN2115622	FL
2	152W00000X	Optometrist	OPC2752	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	:	1376504258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN MISDRAJI OD RN

Provider Business Mailing Address
First Line	:	6641 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3527
Country	:	US
Telephone Number	:	561-738-0112
Fax Number	:	561-935-9359

Provider Business Practice Location Address
First Line	:	6641 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3527
Country	:	US
Telephone Number	:	317-903-2929
Fax Number	:	561-935-9359

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	07/16/2025

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