Healthcare Provider Details

I. General information

NPI: 1710208798
Provider Name (Legal Business Name): JULIA MARIE HENRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

IV. Provider business mailing address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

V. Phone/Fax

Practice location:
  • Phone: 407-537-5516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME123671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: