Basic Information
| Provider Information | |||||||||
| NPI: | 1184086571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVINE | ||||||||
| FirstName: | CARLY | ||||||||
| MiddleName: | ROSE BRAND | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 NW 14TH ST STE 410 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331362115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052437570 | ||||||||
| FaxNumber: | 3052437572 | ||||||||
| Practice Location | |||||||||
| Address1: | 8932 SW 97TH AVE STE D | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331761936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052705050 | ||||||||
| FaxNumber: | 3052703846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2016 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 140575 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | ME140575 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.