Healthcare Provider Details

I. General information

NPI: 1083684245
Provider Name (Legal Business Name): COLLEEN M MORAN-BANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN M MORAN MD

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST FLORIDA HOSPITAL PEDIATRIC HOSPITALISTS
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

1801 LEE RD STE 165
WINTER PARK FL
32789-2127
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0412
  • Fax: 407-975-0413
Mailing address:
  • Phone: 407-975-0412
  • Fax: 407-975-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: