MEDICARE: DR. STACY FRIEDMAN DHS

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1770030942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY FRIEDMAN DHS

Provider Business Mailing Address
First Line	:	11886 FOXBRIAR LAKE TRL
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-7830
Country	:	US
Telephone Number	:	561-899-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH RD STE 110
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3213
Country	:	US
Telephone Number	:	561-899-7669
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	12/17/2019

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