Individual
MS. FANNY POLYDOROFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 N.W. 16TH STREET, MIAMI, FL 33125
(305) 575-7000
Mailing address
841 TANGIER STREET, CORAL GABLES, FL 33134
(239) 898-3089
Taxonomy
Speciality
Code
Description
License number
State
163WG0100X
Gastroenterology Registered Nurse
Primary
9224472
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2398983089
JOB
FL
Enumeration date
03/27/2018
Last updated
03/27/2018
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