Healthcare Provider Details

I. General information

NPI: 1962050021
Provider Name (Legal Business Name): AMY REEDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 482
OCOEE FL
34761-3433
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 482
OCOEE FL
34761-3433
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6444
  • Fax: 407-650-1307
Mailing address:
  • Phone: 321-841-6444
  • Fax: 407-650-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9112486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: