Provider Demographics
NPI:1407165186
Name:BRAIDE, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BRAIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 W MCNAB RD
Mailing Address - Street 2:#214
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5300
Mailing Address - Country:US
Mailing Address - Phone:954-532-9387
Mailing Address - Fax:954-933-7038
Practice Address - Street 1:7300 W MCNAB RD
Practice Address - Street 2:#214
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5300
Practice Address - Country:US
Practice Address - Phone:954-532-9387
Practice Address - Fax:954-933-7038
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty