Provider Demographics
NPI:1366480386
Name:ACOSTA ASHBY, BRENDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:M
Last Name:ACOSTA ASHBY
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3901 NW 79TH AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6554
Mailing Address - Country:US
Mailing Address - Phone:786-845-8989
Mailing Address - Fax:786-845-8615
Practice Address - Street 1:3901 NW 79TH AVE STE 222
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6554
Practice Address - Country:US
Practice Address - Phone:786-845-8989
Practice Address - Fax:786-845-8615
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME95818207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2804298-00Medicaid