Healthcare Provider Details

I. General information

NPI: 1134986441
Provider Name (Legal Business Name): ELON HEALTH PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43378 HIGHWAY 27 STE B
DAVENPORT FL
33837-6816
US

IV. Provider business mailing address

127 W FAIRBANKS AVE STE 447
WINTER PARK FL
32789-4326
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-6996
  • Fax: 407-871-3599
Mailing address:
  • Phone: 407-205-6996
  • Fax: 407-871-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDEEP PANDYA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 407-205-6996