Healthcare Provider Details

I. General information

NPI: 1205820206
Provider Name (Legal Business Name): EDMUND ABATE III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CELEBRATION PL STE 200
CELEBRATION FL
34747-5432
US

IV. Provider business mailing address

410 CELEBRATION PL STE 200
CELEBRATION FL
34747-5432
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4673
  • Fax: 407-303-4674
Mailing address:
  • Phone: 407-303-4673
  • Fax: 407-303-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101934
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9101934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: