Provider Demographics
NPI:1255382537
Name:LYRA, VIOLETTA (MD)
Entity type:Individual
Prefix:DR
First Name:VIOLETTA
Middle Name:
Last Name:LYRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 260
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4721
Mailing Address - Country:US
Mailing Address - Phone:305-466-2496
Mailing Address - Fax:305-466-2497
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 260
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4721
Practice Address - Country:US
Practice Address - Phone:305-466-2496
Practice Address - Fax:305-466-2497
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM30063407207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF65180Medicare UPIN
FL00023254AMedicare ID - Type Unspecified