Healthcare Provider Details

I. General information

NPI: 1922389170
Provider Name (Legal Business Name): MEREDITH SKELTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 CHIPOLA CIR
ORLANDO FL
32839-2801
US

IV. Provider business mailing address

5675 CHIPOLA CIR
ORLANDO FL
32839-2801
US

V. Phone/Fax

Practice location:
  • Phone: 407-233-5900
  • Fax:
Mailing address:
  • Phone: 407-233-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMA56910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: