Healthcare Provider Details

I. General information

NPI: 1689566986
Provider Name (Legal Business Name): AMANDA ELISABETH DOCEKAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 07/19/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MILLENIA BLVD
ORLANDO FL
32839-6012
US

IV. Provider business mailing address

16546 MARIPOSA CIR N
FORT LAUDERDALE FL
33331-4657
US

V. Phone/Fax

Practice location:
  • Phone: 407-264-5601
  • Fax:
Mailing address:
  • Phone: 954-646-4825
  • 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: