Provider Demographics
NPI:1053583856
Name:AMBERLY C PARADOA DPM PA
Entity type:Organization
Organization Name:AMBERLY C PARADOA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMBERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARADOA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-299-7009
Mailing Address - Street 1:3735 11TH CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4844
Mailing Address - Country:US
Mailing Address - Phone:772-299-7009
Mailing Address - Fax:772-562-7138
Practice Address - Street 1:3735 11TH CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4844
Practice Address - Country:US
Practice Address - Phone:772-299-7009
Practice Address - Fax:772-562-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3105213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO3105OtherLICENSE
FL340483800Medicaid
FL6141470001OtherMEDICARE DME
FL6141470001OtherMEDICARE DME
FLPO3105OtherLICENSE
FL340483800Medicaid