Provider Demographics
NPI:1114118478
Name:SPENCER-MORALES, EDITH MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:MICHELLE
Last Name:SPENCER-MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:MICHELLE
Other - Last Name:MORALES-QUILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10101 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6103
Mailing Address - Country:US
Mailing Address - Phone:561-798-8599
Mailing Address - Fax:
Practice Address - Street 1:10101 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6103
Practice Address - Country:US
Practice Address - Phone:561-798-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108900208000000X
FLME1188622080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics