Healthcare Provider Details

I. General information

NPI: 1194395772
Provider Name (Legal Business Name): GROWING TOGETHER PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 E SILVER STAR RD
OCOEE FL
34761-2553
US

IV. Provider business mailing address

5164 S. CONWAY RD.
ORLANDO FL
32812
US

V. Phone/Fax

Practice location:
  • Phone: 407-770-1414
  • Fax: 407-447-8876
Mailing address:
  • Phone: 407-770-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN JAMES MCHAFFIE
Title or Position: CEO
Credential:
Phone: 407-770-1414