Healthcare Provider Details

I. General information

NPI: 1104461581
Provider Name (Legal Business Name): PURVEENA DOOBAY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2019
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S KIRKMAN RD
ORLANDO FL
32811-2346
US

IV. Provider business mailing address

4907 W SOUTH ST
ORLANDO FL
32811-1769
US

V. Phone/Fax

Practice location:
  • Phone: 407-362-2030
  • Fax:
Mailing address:
  • Phone: 407-738-6405
  • 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: