Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | ME124786 | FL |
NPI | 1144453796 |
---|---|
Provider Name | Stefanie Jean-Baptiste Berry |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-5431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2009 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015256900 | (05) | FL |