Provider Demographics
NPI:1093523540
Name:JOSEPH, ABBY DANAH KATHLEEN (SA-C)
Entity type:Individual
Prefix:
First Name:ABBY DANAH KATHLEEN
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:N LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-4707
Mailing Address - Country:US
Mailing Address - Phone:954-737-0740
Mailing Address - Fax:
Practice Address - Street 1:2331 N STATE ROAD 7 STE 220
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3772
Practice Address - Country:US
Practice Address - Phone:954-737-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-578246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant