MEDICARE: BONNIE NEEDLEMAN

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	390200000X	Student in an Organized Health Care Education/Training Program	SZ 6248	FL

General Provider Information

NPI Number	:	1972942050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE NEEDLEMAN

Provider Business Mailing Address
First Line	:	3317 NW 10TH TER
Second Line	:	SUITE 403
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-5941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3317 NW 10TH TER
Second Line	:	SUITE 403
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-5941
Country	:	US
Telephone Number	:	954-537-7949
Fax Number	:

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

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	06/21/2013

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Directions to “ BONNIE NEEDLEMAN ” Practice Location

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