Active NPI
Stephanie Gabriela Mak, DO
- Psychiatry Physician
- Miami, FL
National Provider Identifier
1114505567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- OS21259
- Practice address
- 1611 NW 12TH Ave
Miami, FL 33136-1005 - Phone
- (954) 724-6540
- NPI assigned
- Mar 29, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | OS21259 | FL | Primary |
Addresses
Primary practice location
1611 NW 12TH Ave
Miami, FL 33136-1005
Mailing address
1611 NW 12TH Ave
Miami, FL 33136-1005
Phone (954) 724-6540
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS21259 | FL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723420800000",
"number": "1114505567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1611 NW 12TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331361005",
"telephone_number": "954-724-6540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 NW 12TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331361005",
"telephone_number": "954-724-6540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAK",
"first_name": "STEPHANIE",
"middle_name": "GABRIELA",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-29",
"last_updated": "2024-08-12",
"certification_date": "2024-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "OS21259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.