MEDICARE: ASHLEY BEADE

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	363A00000X	Physician Assistant	PA9118119	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1639830508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BEADE

Provider Business Mailing Address
First Line	:	8333 NW 53RD ST FL 6
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33166-4783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 WASHINGTON ST STE 500B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8259
Country	:	US
Telephone Number	:	954-262-1250
Fax Number	:

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

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	06/01/2026

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Directions to “ ASHLEY BEADE ” Practice Location

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