Provider Demographics
NPI:1952610461
Name:FORLEITER, AMY MIRIAM (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MIRIAM
Last Name:FORLEITER
Suffix:
Gender:F
Credentials:PA-C
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Other - Middle Name:
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Mailing Address - Street 1:2955 NW 126TH AVE UNIT 223-5
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-6334
Mailing Address - Country:US
Mailing Address - Phone:781-254-7377
Mailing Address - Fax:
Practice Address - Street 1:670 GLADES RD STE 220
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6464
Practice Address - Country:US
Practice Address - Phone:561-394-6656
Practice Address - Fax:561-394-4022
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014892363AS0400X
FLPA9109681363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical