MEDICARE: BROOKE SNELL PA-C

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	PA9118443	FL
2	207N00000X	Dermatology Physician	PA9118443	FL

General Provider Information

NPI Number	:	1730944471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE SNELL PA-C

Provider Business Mailing Address
First Line	:	15280 NW 79TH CT STE 200
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5873
Country	:	US
Telephone Number	:	305-558-3724
Fax Number	:	954-744-4839

Provider Business Practice Location Address
First Line	:	21550 BISCAYNE BLVD STE 202A
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33180-1258
Country	:	US
Telephone Number	:	305-707-0368
Fax Number	:	954-744-4839

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

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	02/15/2026

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Directions to “ BROOKE SNELL PA-C” Practice Location

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