MEDICARE: BROWARD MEDICAL AND WELLNESS

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	261Q00000X	Clinic/Center	PA9104589	FL

General Provider Information

NPI Number	:	1811441306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD MEDICAL AND WELLNESS

Provider Business Mailing Address
First Line	:	2250 PALM BEACH LAKES BLVD
Second Line	:	SUITE 106
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3407
Country	:	US
Telephone Number	:	561-939-2710
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 PALM BEACH LAKES BLVD
Second Line	:	SUITE 106
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3407
Country	:	US
Telephone Number	:	561-939-2710
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANETA DADASHEV
Credential	:	PA
Telephone Number	:	305-904-6310

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	08/12/2016

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Directions to “BROWARD MEDICAL AND WELLNESS ” Practice Location

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