MEDICARE: DR. AMAYA P. FERNANDEZ

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	1223G0001X	General Practice Dentistry	DN15648	FL

General Provider Information

NPI Number	:	1851502645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMAYA P. FERNANDEZ

Provider Business Mailing Address
First Line	:	7415 MIAMI LAKES DR
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6818
Country	:	US
Telephone Number	:	305-512-0066
Fax Number	:	305-826-5466

Provider Business Practice Location Address
First Line	:	7415 MIAMI LAKES DR
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6818
Country	:	US
Telephone Number	:	305-512-0066
Fax Number	:	305-826-5466

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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