Healthcare Provider Details

I. General information

NPI: 1942252689
Provider Name (Legal Business Name): FAMILY PHYSICIANS OF WINTER PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 W COLONIAL DR
ORLANDO FL
32818-7812
US

IV. Provider business mailing address

5454 CENTRAL FLORIDA PKWY
ORLANDO FL
32821-8774
US

V. Phone/Fax

Practice location:
  • Phone: 407-447-4283
  • Fax: 407-447-4274
Mailing address:
  • Phone: 407-239-0771
  • Fax: 407-239-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME77880
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME58522
License Number StateFL

VIII. Authorized Official

Name: NAYANA I VYAS
Title or Position: FOUNDER
Credential: M.D.
Phone: 407-293-2930