Provider Demographics
NPI:1376504258
Name:MISDRAJI, ROSALYN (OD RN)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:MISDRAJI
Suffix:
Gender:F
Credentials:OD RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 W BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3527
Mailing Address - Country:US
Mailing Address - Phone:561-738-0112
Mailing Address - Fax:561-935-9359
Practice Address - Street 1:6641 W BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3527
Practice Address - Country:US
Practice Address - Phone:561-738-0112
Practice Address - Fax:561-935-9359
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2752152W00000X
FLRN2115622163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59634Medicare UPIN