Healthcare Provider Details

I. General information

NPI: 1518475938
Provider Name (Legal Business Name): AMBER DANIELECKI BUZZI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N MILLS AVE STE 107
ORLANDO FL
32803-1444
US

IV. Provider business mailing address

3390 FAWNWOOD DR
OCOEE FL
34761-4433
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-4880
  • Fax:
Mailing address:
  • Phone: 727-710-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9111039
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: