Basic Information
| Provider Information | |||||||||
| NPI: | 1992344055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUNDORA | ||||||||
| FirstName: | DANISLEIDYS | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12741 MIRAMAR PKWY STE 302 | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330272905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546029723 | ||||||||
| FaxNumber: | 9546029724 | ||||||||
| Practice Location | |||||||||
| Address1: | 12741 MIRAMAR PKWY STE 302 | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330272905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546029723 | ||||||||
| FaxNumber: | 9546029724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2020 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN11004709 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.