MEDICARE: NOVA SOUTHEASTERN UNIVERSITY, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133V00000X	Registered Dietitian
2	152W00000X	Optometrist
3	171100000X	Acupuncturist
4	204D00000X	Neuromusculoskeletal Medicine & OMM Physician
5	225100000X	Physical Therapist
6	133N00000X	Nutritionist
7	103T00000X	Psychologist
8	207QS0010X	Sports Medicine (Family Medicine) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	98673	OTHER	FL	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1720126584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA SOUTHEASTERN UNIVERSITY, INC.

Provider Business Mailing Address
First Line	:	3200 S UNIVERSITY DR
Second Line	:	SANFORD L. ZIFF BLDG, 3RD FLOOR, ROOM 4364-D
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33328-2018
Country	:	US
Telephone Number	:	954-262-4343
Fax Number	:	954-262-1172

Provider Business Practice Location Address
First Line	:	3301 COLLEGE AVE
Second Line	:	UNIVERSITY CENTER ROOM 1433
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33314-7721
Country	:	US
Telephone Number	:	954-262-5590
Fax Number	:	954-262-5570

Authorized Official
Title or Position	:	DIR OF CONTRACTING AND CREDEN
Name	:	ROSEMERY ESTEVEZ
Credential	:
Telephone Number	:	954-262-4343

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	05/24/2023

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