Provider Demographics
NPI:1447299300
Name:BERKSHIRE, TIFFANY LEE (DO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:BERKSHIRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:BERKSHIRE
Other - Last Name:FRAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14771 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1217
Mailing Address - Country:US
Mailing Address - Phone:305-945-7745
Mailing Address - Fax:305-945-7740
Practice Address - Street 1:2344 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3249
Practice Address - Country:US
Practice Address - Phone:305-945-7745
Practice Address - Fax:305-945-7740
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7645207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257318100Medicaid
FL257318100Medicaid
FL44953YMedicare ID - Type Unspecified