Healthcare Provider Details

I. General information

NPI: 1609320837
Provider Name (Legal Business Name): STARUS PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 VINELAND RD STE 103
ORLANDO FL
32819-7829
US

IV. Provider business mailing address

6001 VINELAND RD STE 103
ORLANDO FL
32819-7829
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-8814
  • Fax: 407-978-6507
Mailing address:
  • Phone: 407-483-8814
  • Fax: 407-978-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberACN437
License Number StateFL

VIII. Authorized Official

Name: DR. EDEL VALDES
Title or Position: OWNER
Credential: MD
Phone: 407-483-8814