Healthcare Provider Details

I. General information

NPI: 1447728381
Provider Name (Legal Business Name): CHUNG YEN SHIAU ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 W IRLO BRONSON HWY
KISSIMMEE FL
34746-4754
US

IV. Provider business mailing address

13198 LOOKING GLASS FALLS LN
ORLANDO FL
32824-4350
US

V. Phone/Fax

Practice location:
  • Phone: 407-390-9431
  • Fax:
Mailing address:
  • Phone: 407-982-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: