Provider Demographics
NPI:1083029771
Name:ROACH, ALDYTH IRMA
Entity Type:Individual
Prefix:MS
First Name:ALDYTH
Middle Name:IRMA
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12605 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4813
Mailing Address - Country:US
Mailing Address - Phone:305-893-9883
Mailing Address - Fax:305-893-5352
Practice Address - Street 1:12605 NE 7TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4813
Practice Address - Country:US
Practice Address - Phone:305-893-9883
Practice Address - Fax:305-893-5352
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-22
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1209572471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography