Individual
IDARA NDOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 SARNO RD STE 119J, MELBOURNE, FL 32935-4938
(321) 414-2248
(877) 515-0334
Mailing address
125 REMOUNT RD, SUITE C1 #568, CHARLOTTE, NC 28203
(850) 545-9063
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720617335
NPI
FL
Enumeration date
02/13/2023
Last updated
02/13/2023
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