Healthcare Provider Details

I. General information

NPI: 1629503750
Provider Name (Legal Business Name): ELAINE FELIX DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 VILLAGE OAK LN
KISSIMMEE FL
34746-6558
US

IV. Provider business mailing address

15815 SHADDOCK DR STE 130
WINTER GARDEN FL
34787-5773
US

V. Phone/Fax

Practice location:
  • Phone: 407-518-7747
  • Fax: 877-810-6064
Mailing address:
  • Phone: 407-605-2321
  • Fax: 407-671-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4157
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: