Healthcare Provider Details

I. General information

NPI: 1306431218
Provider Name (Legal Business Name): DAVID DIGIANDOMENICO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 W COUNTY ROAD 419 STE 1041
CHULUOTA FL
32766-9520
US

IV. Provider business mailing address

382 PALM DR
OVIEDO FL
32765-9532
US

V. Phone/Fax

Practice location:
  • Phone: 407-366-2890
  • Fax: 407-542-1012
Mailing address:
  • Phone: 954-243-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPA9114085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: