Provider Demographics
NPI:1992987648
Name:LISSADE, FLORENCE
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:LISSADE
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 1:915 NE 125TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5722
Mailing Address - Country:US
Mailing Address - Phone:305-981-4290
Mailing Address - Fax:305-981-4299
Practice Address - Street 1:915 NE 125TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5722
Practice Address - Country:US
Practice Address - Phone:305-981-4290
Practice Address - Fax:305-981-4299
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator