Healthcare Provider Details

I. General information

NPI: 1396216529
Provider Name (Legal Business Name): DYLAN CHRISTOPHER PAPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 340
ORLANDO FL
32804-4601
US

IV. Provider business mailing address

2200 DOULTON DR
ORLANDO FL
32812-8408
US

V. Phone/Fax

Practice location:
  • Phone: 407-895-8890
  • Fax:
Mailing address:
  • Phone: 860-836-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: