Healthcare Provider Details

I. General information

NPI: 1053880054
Provider Name (Legal Business Name): ASSOCIATES IN UROGYNECOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 W GORE ST STE 201
ORLANDO FL
32806-1124
US

IV. Provider business mailing address

1111 VENETIAN AVE
ORLANDO FL
32804-2149
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-6190
  • Fax: 866-307-6193
Mailing address:
  • Phone: 516-491-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH M ST. LOUIS
Title or Position: OWNER
Credential: MD
Phone: 516-491-9134