Healthcare Provider Details

I. General information

NPI: 1063212801
Provider Name (Legal Business Name): SAMANTHA RODRIGUEZ MALDONADO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

4389 DESERT ROSE AVE
KISSIMMEE FL
34746-2325
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3040
  • Fax: 321-841-3049
Mailing address:
  • Phone: 407-234-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: