Provider Demographics
NPI:1518361948
Name:MACHADO, SOLANGIE (ADMINISTRATOR)
Entity Type:Individual
Prefix:MRS
First Name:SOLANGIE
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 TAFT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4062
Mailing Address - Country:US
Mailing Address - Phone:954-780-5566
Mailing Address - Fax:954-780-5567
Practice Address - Street 1:330 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1770
Practice Address - Country:US
Practice Address - Phone:954-780-5566
Practice Address - Fax:954-780-5567
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74274261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL471141278OtherIRS DEPARTMENT OF TREASURY