Individual
DR. NICOLE ANN MAVRIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 NW 14TH ST, SUITE 1466, MIAMI, FL 33136-2107
(305) 243-2861
(305) 243-8532
Mailing address
1120 NW 14TH ST, SUITE 1466, MIAMI, FL 33136-2107
(305) 243-2861
(305) 243-8532
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
ME 111503
FL
2084P0800X
Psychiatry Physician
ME 111503
FL
2084P0804X
Child & Adolescent Psychiatry Physician
250167
NY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
ME 111503
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004138900
—
FL
01
—
250167
NY STATE LICENSE
NY
01
—
ME 111503
FL STATE LICENSE
FL
Enumeration date
05/19/2007
Last updated
09/04/2014
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