Provider Demographics
NPI:1730937533
Name:MATSUDO, PAMELLA KEI (RNFA)
Entity type:Individual
Prefix:
First Name:PAMELLA
Middle Name:KEI
Last Name:MATSUDO
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N BAYSHORE DR APT 4204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3235
Mailing Address - Country:US
Mailing Address - Phone:786-397-9115
Mailing Address - Fax:
Practice Address - Street 1:1800 N BAYSHORE DR APT 4204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3235
Practice Address - Country:US
Practice Address - Phone:786-397-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9658192163WR0006X
FL22-369246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant