Healthcare Provider Details

I. General information

NPI: 1285169177
Provider Name (Legal Business Name): ORLANDO PHYSICIANS GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5385 CONROY RD SUITE 100
ORLANDO FL
32811-3719
US

IV. Provider business mailing address

5385 CONROY RD STE 100&104
ORLANDO FL
32811-3719
US

V. Phone/Fax

Practice location:
  • Phone: 407-777-8794
  • Fax: 689-208-1222
Mailing address:
  • Phone: 407-777-8794
  • Fax: 689-208-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME128383
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME128383
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME132161
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME132161
License Number StateFL

VIII. Authorized Official

Name: SHREYA N PATEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 814-380-3443