MEDICARE: MOMMYMD PLLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1720932858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMMYMD PLLC

Provider Business Mailing Address
First Line	:	19090 SKYRIDGE CIR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-6223
Country	:	US
Telephone Number	:	732-239-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	19090 SKYRIDGE CIR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-6223
Country	:	US
Telephone Number	:	732-239-0399
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/CEO
Name	:	DR. ARIELLA K KHAITOV
Credential	:	MD
Telephone Number	:	732-239-0399

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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