Provider Demographics
NPI:1336660794
Name:MACHADO AMADOR, MIRIAM BEATRIZ
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:BEATRIZ
Last Name:MACHADO AMADOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 SW 200TH ST APT A109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8297
Mailing Address - Country:US
Mailing Address - Phone:786-908-7720
Mailing Address - Fax:
Practice Address - Street 1:3498 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4014
Practice Address - Country:US
Practice Address - Phone:786-805-0212
Practice Address - Fax:786-332-3279
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator