MEDICARE: HEIDY CHANNEL FERNANDEZ PHYSICAL ASSISTANT

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	9113973	FL

General Provider Information

NPI Number	:	1548816069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDY CHANNEL FERNANDEZ PHYSICAL ASSISTANT

Provider Business Mailing Address
First Line	:	1440 ROYAL PALM BEACH BLVD STE A
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1608
Country	:	US
Telephone Number	:	561-784-4481
Fax Number	:	561-784-4496

Provider Business Practice Location Address
First Line	:	1440 ROYAL PALM BEACH BLVD STE A
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1608
Country	:	US
Telephone Number	:	561-784-4481
Fax Number	:	561-784-4496

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

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	07/15/2025

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Directions to “ HEIDY CHANNEL FERNANDEZ PHYSICAL ASSISTANT” Practice Location

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