Provider Demographics
NPI:1639055247
Name:TADESSE, AMANUEL KASSA
Entity type:Individual
Prefix:
First Name:AMANUEL
Middle Name:KASSA
Last Name:TADESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARAKI STREET GONDAR
Mailing Address - Street 2:
Mailing Address - City:GONDAR
Mailing Address - State:AMAHARE
Mailing Address - Zip Code:00196
Mailing Address - Country:ET
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12 AVENUE, MIAMI FL 33136
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-355-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program