Healthcare Provider Details

I. General information

NPI: 1164910691
Provider Name (Legal Business Name): HEATHER SCHENCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

1465 GRANVILLE DR
WINTER PARK FL
32789-1424
US

V. Phone/Fax

Practice location:
  • Phone: 954-649-7925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: