Active NPI
Aundrea Elnora Mack, M.D
- Developmental Therapist
- Pompano Beach, FL
National Provider Identifier
1073866919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 2708 NE 14TH St Apt 5
Pompano Beach, FL 33062-3564 - Phone
- (888) 880-9270
- NPI assigned
- Oct 16, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
2708 NE 14TH St Apt 5
Pompano Beach, FL 33062-3564
Mailing address
325 Spears Creek Church Rd
Apt 17
Elgin, SC 29045-8299
Phone (843) 263-5700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350345600000",
"number": "1073866919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 SPEARS CREEK CHURCH RD",
"address_2": "APT 17",
"city": "ELGIN",
"state": "SC",
"postal_code": "290458299",
"telephone_number": "843-263-5700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2708 NE 14TH ST APT 5",
"city": "POMPANO BEACH",
"state": "FL",
"postal_code": "330623564",
"telephone_number": "888-880-9270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "AUNDREA",
"middle_name": "ELNORA",
"name_prefix": "Miss",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-16",
"last_updated": "2012-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pompano Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.