Healthcare Provider Details

I. General information

NPI: 1467062943
Provider Name (Legal Business Name): GEORGE PAPPAS CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W. HIBISCUS BLVD. STE 215
MELBOURNE FL
32901
US

IV. Provider business mailing address

220 W SEAVIEW AVE
LINWOOD NJ
08221
US

V. Phone/Fax

Practice location:
  • Phone: 321-837-3820
  • Fax:
Mailing address:
  • Phone: 609-892-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: