Provider Demographics
NPI:1811441306
Name:BROWARD MEDICAL AND WELLNESS
Entity type:Organization
Organization Name:BROWARD MEDICAL AND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANETA
Authorized Official - Middle Name:
Authorized Official - Last Name:DADASHEV
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-904-6310
Mailing Address - Street 1:2250 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3407
Mailing Address - Country:US
Mailing Address - Phone:561-939-2710
Mailing Address - Fax:
Practice Address - Street 1:2250 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3407
Practice Address - Country:US
Practice Address - Phone:561-939-2710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104589261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center