Provider Demographics
NPI:1508956715
Name:MASRI, AMAL A (DPM)
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:A
Last Name:MASRI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16800 NW 2ND AVE
Mailing Address - Street 2:STE 309
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5508
Mailing Address - Country:US
Mailing Address - Phone:305-654-7753
Mailing Address - Fax:305-673-9259
Practice Address - Street 1:73 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6017
Practice Address - Country:US
Practice Address - Phone:305-654-7753
Practice Address - Fax:305-673-9259
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2553213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU67400Medicare UPIN
FL65523Medicare ID - Type Unspecified