Provider Demographics
NPI:1376788372
Name:MERCADO, AMIZADAY MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:AMIZADAY
Middle Name:MARIE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10741 NW 29TH CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-1017
Mailing Address - Country:US
Mailing Address - Phone:954-793-1342
Mailing Address - Fax:
Practice Address - Street 1:10741 NW 29TH CT
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-1017
Practice Address - Country:US
Practice Address - Phone:954-793-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist