Audrey Elaine Dericho

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

15131 Tyler St
Miami, FL 33176-7644

Phone

(786) 205-5491

NPI assigned

Aug 14, 2023

Last updated

Aug 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1700669850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10905 SW 214TH ST APT 102",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331893093",
            "telephone_number": "786-205-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15131 TYLER ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331767644",
            "telephone_number": "786-205-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERICHO",
        "first_name": "AUDREY",
        "middle_name": "ELAINE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Independent Duty Medical Technicians in Miami, FL
• Providers in Miami, FL by specialty
• Independent Duty Medical Technicians in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.