Provider Demographics
NPI:1053313510
Name:AQUA, AMY ZARON (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ZARON
Last Name:AQUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5063 10TH AVE N
Mailing Address - Street 2:PALM BEACH PEDIATRICS
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2048
Mailing Address - Country:US
Mailing Address - Phone:561-683-7093
Mailing Address - Fax:561-471-0887
Practice Address - Street 1:12955 PALMS WEST DR
Practice Address - Street 2:SUITE 100 BUILDING 8
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4993
Practice Address - Country:US
Practice Address - Phone:561-798-2468
Practice Address - Fax:561-798-2733
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0068770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1202769OtherUNITED
FL41559OtherBS
FL41559OtherBS