Healthcare Provider Details

I. General information

NPI: 1194505339
Provider Name (Legal Business Name): TRAYVOND ETIENNE MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 E COLONIAL DR
ORLANDO FL
32803-5230
US

IV. Provider business mailing address

3901 E COLONIAL DR
ORLANDO FL
32803-5230
US

V. Phone/Fax

Practice location:
  • Phone: 407-972-0924
  • Fax: 407-930-6070
Mailing address:
  • Phone: 407-972-0924
  • Fax: 407-930-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number1076885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: