Provider Demographics
NPI:1679108773
Name:PEREZ, MADELEY
Entity Type:Individual
Prefix:
First Name:MADELEY
Middle Name:
Last Name:PEREZ
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 1:6447 MIAMI LAKES DR E STE 222D
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2764
Mailing Address - Country:US
Mailing Address - Phone:786-915-9917
Mailing Address - Fax:
Practice Address - Street 1:6447 MIAMI LAKES DR E STE 222D
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2764
Practice Address - Country:US
Practice Address - Phone:786-915-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide