Nicole Ann Mavrides, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME 111503 Issued in FL

Practice address

1120 NW 14TH St
Suite 1466
Miami, FL 33136-2107

Phone

(305) 243-2861

Fax

(305) 243-8532

NPI assigned

May 19, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• University of Miami

  • Hepatology Physician
  • Miami, FL
  • NPI 1013967827
  Medicare reassignment NPD
• University of Miami

  • Internal Medicine Physician
  • Miami Beach, FL
  • NPI 1124768627
  NPD
• PM Pediatrics BH II, P.C.

  • Urgent Care Clinic/Center
  • Wayne, PA
  • NPI 1861146821
  NPD (past)
• PM Pediatrics of Bayside PLLC

  • Urgent Care Clinic/Center
  • Nanuet, NY
  • NPI 1861823197
  NPD (past)
• PM Pediatrics of Mamaroneck

  • Urgent Care Clinic/Center
  • Mamaroneck, NY
  • NPI 1073645180
  NPD (past)
• PM Pediatrics PC

  • Urgent Care Clinic/Center
  • Syosset, NY
  • NPI 1730212390
  NPD (past)

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

{
    "created_epoch": "1179532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409788800000",
    "number": "1205044476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 NW 14TH ST",
            "address_2": "SUITE 1466",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331362107",
            "telephone_number": "305-243-2861",
            "fax_number": "305-243-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 NW 14TH ST",
            "address_2": "SUITE 1466",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331362107",
            "telephone_number": "305-243-2861",
            "fax_number": "305-243-8532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVRIDES",
        "first_name": "NICOLE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-19",
        "last_updated": "2014-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "250167",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME 111503",
            "primary": true
        },
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "FL",
            "license": "ME 111503",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME 111503",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE LICENSE",
            "identifier": "250167",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL STATE LICENSE",
            "identifier": "ME 111503",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004138900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackson Briggs Maute
• Mava Service Inc
• Maven in Behavior LLC
• Maverick Supply USA LLC
• Mavic Medical Center
• Max Care Solution, Inc.
• Max Care Solutions LLC
• Max Community Wellness Center Inc
• Max Pazos MD PA
• Max Physical Therapy Inc.

• Child & Adolescent Psychiatry Physician in Miami, FL
• Providers in Miami, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.