Healthcare Provider Details

I. General information

NPI: 1447378054
Provider Name (Legal Business Name): WINDERMERE ALLERGY & ASTHMA,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8946 CONROY WINDERMERE RD
ORLANDO FL
32835-3128
US

IV. Provider business mailing address

8946 CONROY WINDERMERE RD
ORLANDO FL
32835-3128
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-1009
  • Fax: 407-876-6742
Mailing address:
  • Phone: 407-876-1009
  • Fax: 407-876-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME68693
License Number StateFL

VIII. Authorized Official

Name: DR. DANA L BROUSSARD-PERRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-876-1009