Provider Demographics
NPI: | 1710318324 |
---|---|
Name: | MAYUNGBE, ALBERT SR (CPA) |
Entity Type: | Individual |
Prefix: | |
First Name: | ALBERT |
Middle Name: | |
Last Name: | MAYUNGBE |
Suffix: | SR |
Gender: | M |
Credentials: | CPA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 111 NW 183RD ST STE 402 |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33169-4540 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-342-1715 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 111 NW 183RD ST STE 402 |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33169-4540 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-342-1715 |
Practice Address - Fax: | 305-651-4900 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2013-12-06 |
Last Update Date: | 2013-12-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 299993690 | 163W00000X, 164W00000X, 224Z00000X, 225100000X, 2251E1200X, 225200000X, 225X00000X, 225XE1200X, 235Z00000X, 376K00000X |
FL | 16855 | 376J00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | |
No | 376J00000X | Nursing Service Related Providers | Homemaker | |
No | 376K00000X | Nursing Service Related Providers | Nurse's Aide |