MEDICARE: OLGA STEPHANIE ROMAN

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	363AM0700X	Medical Physician Assistant	PA9115289	FL

General Provider Information

NPI Number	:	1699431155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA STEPHANIE ROMAN

Provider Business Mailing Address
First Line	:	5301 N FEDERAL HWY STE 165
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-4914
Country	:	US
Telephone Number	:	561-705-1389
Fax Number	:

Provider Business Practice Location Address
First Line	:	3346 GRIFFIN RD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-5519
Country	:	US
Telephone Number	:	954-361-8239
Fax Number	:

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

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	05/25/2022

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Directions to “ OLGA STEPHANIE ROMAN ” Practice Location

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