MEDICARE: MRS. PRIYA PHILIP 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	PA9109876	FL

General Provider Information

NPI Number	:	1740730779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRIYA PHILIP PA-C

Provider Business Mailing Address
First Line	:	4184 CASCADA CIR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8516
Country	:	US
Telephone Number	:	954-632-1548
Fax Number	:

Provider Business Practice Location Address
First Line	:	4184 CASCADA CIR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8516
Country	:	US
Telephone Number	:	954-632-1548
Fax Number	:

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

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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