MEDICARE: DR. AMANDA RUTH ALLADIN MBBS

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	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	ME116535	FL
2	2080P0203X	Pediatric Critical Care Medicine Physician	ME116535	FL

General Provider Information

NPI Number	:	1669780656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA RUTH ALLADIN MBBS

Provider Business Mailing Address
First Line	:	1611 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1005
Country	:	US
Telephone Number	:	305-585-7456
Fax Number	:	305-585-0293

Provider Business Practice Location Address
First Line	:	1611 NW 12TH AVE
Second Line	:	PEDIATRIC DEPARTMENT
City	:	MIAMI
State	:	FL
Zip	:	33136-1005
Country	:	US
Telephone Number	:	305-585-6042
Fax Number	:

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

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	07/29/2021

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