Healthcare Provider Details

I. General information

NPI: 1134813322
Provider Name (Legal Business Name): FREDNA ENDROT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 W COLONIAL DR STE 100
ORLANDO FL
32808-7504
US

IV. Provider business mailing address

931 W OAK ST STE 103
KISSIMMEE FL
34741-4973
US

V. Phone/Fax

Practice location:
  • Phone: 407-931-0444
  • Fax:
Mailing address:
  • Phone: 407-931-0444
  • Fax: 407-962-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1618
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23672
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: