Healthcare Provider Details

I. General information

NPI: 1609884253
Provider Name (Legal Business Name): REELI REINU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 LAKE LUCIEN DR STE 180
MAITLAND FL
32751-7235
US

IV. Provider business mailing address

1768 PARK CENTER DR STE 300
ORLANDO FL
32835-6256
US

V. Phone/Fax

Practice location:
  • Phone: 407-875-2080
  • Fax: 407-875-0518
Mailing address:
  • Phone: 407-445-9445
  • Fax: 407-293-3908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: