Provider Demographics
NPI:1083982649
Name:WOMEN AND TEENS HEALTHCARE INC
Entity Type:Organization
Organization Name:WOMEN AND TEENS HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAITHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-895-5555
Mailing Address - Street 1:16876 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3108
Mailing Address - Country:US
Mailing Address - Phone:305-895-5555
Mailing Address - Fax:305-947-0061
Practice Address - Street 1:16876 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3108
Practice Address - Country:US
Practice Address - Phone:305-895-5555
Practice Address - Fax:305-947-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME062140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275868700Medicaid