Mirna Antonieta Waidele, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9101003 Issued in FL

Practice address

7100 W Camino Real
Suite 200
Boca Raton, FL 33433-5510

Phone

(561) 391-6552

Fax

(561) 391-6285

NPI assigned

Jul 21, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10036/brand/2/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• SBM Rehabilitation Medical Center Inc

  • Internal Medicine Physician
  • Palm Springs, FL
  • NPI 1528000981
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1013938778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 W CAMINO REAL",
            "address_2": "SUITE 200",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334335510",
            "telephone_number": "561-391-6552",
            "fax_number": "561-391-6285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 W CAMINO REAL",
            "address_2": "SUITE 200",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334335510",
            "telephone_number": "561-391-6552",
            "fax_number": "561-391-6285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAIDELE",
        "first_name": "MIRNA",
        "middle_name": "ANTONIETA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherrie Wade, LMHC 3015
• Matthew R Waggoner, PT
• Amanda Wagner
• Melissa Anne Wagner, DOCTOR OF PHARMACY
• Sara Wahba, MD
• Daniel Jeremy Waintraub, M.D.
• Dolores Wainwright, MS CCC-SLP
• Ashley Waknine
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP

• Medical Physician Assistant in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.