Healthcare Provider Details

I. General information

NPI: 1023283967
Provider Name (Legal Business Name): DAMASK PHYSICIANS GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 PRIMERA BLVD SUITE 1031
LAKE MARY FL
32746-2191
US

IV. Provider business mailing address

795 PRIMERA BLVD SUITE 1031
LAKE MARY FL
32746-2191
US

V. Phone/Fax

Practice location:
  • Phone: 407-829-8981
  • Fax: 407-942-1049
Mailing address:
  • Phone: 407-829-8981
  • Fax: 407-942-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: CECELIA DAMASK
Title or Position: PHYSICIAN
Credential: DO
Phone: 407-829-8981