Healthcare Provider Details

I. General information

NPI: 1144209669
Provider Name (Legal Business Name): MARISELLY MEDINA-IRIZARRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 FUTURES DR STE 7
ORLANDO FL
32819-9076
US

IV. Provider business mailing address

8803 FUTURES DR STE 7
ORLANDO FL
32819-9076
US

V. Phone/Fax

Practice location:
  • Phone: 407-219-5936
  • Fax: 407-480-3455
Mailing address:
  • Phone: 407-219-5936
  • Fax: 407-480-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME93134
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME93134
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME93134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: