Healthcare Provider Details

I. General information

NPI: 1962734004
Provider Name (Legal Business Name): MEGHAN GAROFALO BATES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2010
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 LAKE UNDERHILL RD SUITE 150
ORLANDO FL
32822-8202
US

IV. Provider business mailing address

7975 LAKE UNDERHILL RD SUITE 150
ORLANDO FL
32822-8202
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-8110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1090751
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9106602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: