Healthcare Provider Details

I. General information

NPI: 1356567788
Provider Name (Legal Business Name): JUAN CARLOS ESCANDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 RIDGE CENTER DR STE 104
DAVENPORT FL
33837-6414
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 863-421-9447
  • Fax: 863-421-1806
Mailing address:
  • Phone: 407-845-0330
  • Fax: 888-972-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME109282
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberME109282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: