Healthcare Provider Details

I. General information

NPI: 1942628235
Provider Name (Legal Business Name): QUYNHAN CHAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 N SEMORAN BLVD STE 200
ORLANDO FL
32807-3530
US

IV. Provider business mailing address

1287 N SEMORAN BLVD STE 200
ORLANDO FL
32807-3530
US

V. Phone/Fax

Practice location:
  • Phone: 407-273-9410
  • Fax:
Mailing address:
  • Phone: 407-273-9410
  • Fax: 407-658-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME130746
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME130746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: