Provider Demographics
NPI:1154396281
Name:LANDESS, CARRIE (MD, PA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LANDESS
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16855 NE 2ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1744
Mailing Address - Country:US
Mailing Address - Phone:305-655-2800
Mailing Address - Fax:305-655-2801
Practice Address - Street 1:16855 NE 2ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1744
Practice Address - Country:US
Practice Address - Phone:305-655-2800
Practice Address - Fax:305-655-2801
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME661992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257784400Medicaid
FL25460TMedicare PIN
FLF87547Medicare UPIN