MEDICARE: EMDI HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	133V00000X	Registered Dietitian
3	207QA0505X	Adult Medicine Physician
4	2084P0800X	Psychiatry Physician
5	251F00000X	Home Infusion Agency
6	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417670357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMDI HEALTH LLC

Provider Business Mailing Address
First Line	:	2213 FUNSTON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 WASHINGTON ST STE 104
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8291
Country	:	US
Telephone Number	:	857-262-1620
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR/OWNER
Name	:	JENNIFER MBIANDA
Credential	:	MD
Telephone Number	:	404-287-8862

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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Directions to “EMDI HEALTH LLC ” Practice Location

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