Provider Demographics
NPI:1962400713
Name:PARADOA, AMBERLY C (DPM)
Entity type:Individual
Prefix:
First Name:AMBERLY
Middle Name:C
Last Name:PARADOA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3105213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01024Medicare UPIN
FLU2969AMedicare PIN