Provider Demographics
NPI:1629473673
Name:MADDY, CARMELO
Entity Type:Individual
Prefix:
First Name:CARMELO
Middle Name:
Last Name:MADDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3607
Mailing Address - Country:US
Mailing Address - Phone:305-956-2707
Mailing Address - Fax:305-956-9079
Practice Address - Street 1:16601 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-3607
Practice Address - Country:US
Practice Address - Phone:305-956-2707
Practice Address - Fax:305-956-9079
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP93822878363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care