Healthcare Provider Details

I. General information

NPI: 1770043754
Provider Name (Legal Business Name): ALEXANDRIA MAYNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

107 CAMERON CT
WESTON FL
33326-3518
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-5218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME182470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: