Provider Demographics
NPI:1962709899
Name:AMBERLY PARADOA DPM PA
Entity type:Organization
Organization Name:AMBERLY PARADOA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARADOA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-299-7009
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:772-568-7138
Practice Address - Street 1:1627 US HIGHWAY 1
Practice Address - Street 2:SUITE 208
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3899
Practice Address - Country:US
Practice Address - Phone:772-589-9970
Practice Address - Fax:772-589-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3105335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65862OtherBLUE CROSS BLUE SHIELD
FL340483800Medicaid
FLAK097Medicare PIN