Basic Information
| Provider Information | |||||||||
| NPI: | 1194116004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACHADO | ||||||||
| FirstName: | DESIREE | ||||||||
| MiddleName: | M M S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100297 | ||||||||
| Address2: | CONGENITAL HEART CENTER | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522735422 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522735422 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 03/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | MFC1732 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 014369800 | 05 | FL | MEDICAID |