Healthcare Provider Details

I. General information

NPI: 1053676650
Provider Name (Legal Business Name): JASON CHENG-EN SEA MD, FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PARK CENTER DR STE 130
ORLANDO FL
32835-7611
US

IV. Provider business mailing address

2101 PARK CENTER DR STE 130
ORLANDO FL
32835-7611
US

V. Phone/Fax

Practice location:
  • Phone: 407-298-6950
  • Fax: 407-578-2354
Mailing address:
  • Phone: 407-298-6950
  • Fax: 407-578-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME116852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: