Provider Demographics
NPI:1134701584
Name:ALEXANDRA DA ROCHA HENSLEY, MD PLLC
Entity Type:Organization
Organization Name:ALEXANDRA DA ROCHA HENSLEY, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DA ROCHA HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-591-9991
Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3771
Mailing Address - Country:US
Mailing Address - Phone:954-803-3606
Mailing Address - Fax:909-265-9522
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD STE 303
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3771
Practice Address - Country:US
Practice Address - Phone:850-591-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113852500Medicaid