Healthcare Provider Details

I. General information

NPI: 1194351197
Provider Name (Legal Business Name): KAYO HENRIQUE FERNANDES E MAGALHAES SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S SEMORAN BLVD STE A
ORLANDO FL
32822-2472
US

IV. Provider business mailing address

4445 S SEMORAN BLVD STE A
ORLANDO FL
32822-2472
US

V. Phone/Fax

Practice location:
  • Phone: 407-203-8957
  • Fax:
Mailing address:
  • Phone: 407-203-8957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME160443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: