Basic Information
| Provider Information | |||||||||
| NPI: | 1447518592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMIN | ||||||||
| FirstName: | MONA | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 S PINE ISLAND RD STE 800 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549629022 | ||||||||
| FaxNumber: | 9549663616 | ||||||||
| Practice Location | |||||||||
| Address1: | 789 S FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333161245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543155784 | ||||||||
| FaxNumber: | 9545220755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2012 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 279339-1 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | OS14518 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 020365000 | 05 | FL | MEDICAID |