Healthcare Provider Details

I. General information

NPI: 1528892049
Provider Name (Legal Business Name): AMERICAN NEUROPATHY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 TURKEY LAKE RD # 691232
ORLANDO FL
32819-8027
US

IV. Provider business mailing address

10450 TURKEY LAKE RD # 691232
ORLANDO FL
32819-8027
US

V. Phone/Fax

Practice location:
  • Phone: 407-624-2844
  • Fax: 800-526-9317
Mailing address:
  • Phone: 407-624-2844
  • Fax: 800-526-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA WAGENER
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: ADMINISTRATOR
Phone: 407-624-2844