Provider Demographics
NPI:1710118179
Name:AMMA MIDWIFERY LLC
Entity Type:Organization
Organization Name:AMMA MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:LARA
Authorized Official - Last Name:SARDESHMUKH
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:305-310-3710
Mailing Address - Street 1:PO BOX 14845
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33101-4845
Mailing Address - Country:US
Mailing Address - Phone:305-310-3710
Mailing Address - Fax:305-400-0295
Practice Address - Street 1:1637 SW 8TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-5243
Practice Address - Country:US
Practice Address - Phone:305-310-3710
Practice Address - Fax:305-400-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 228176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001285000Medicaid