Healthcare Provider Details

I. General information

NPI: 1720540552
Provider Name (Legal Business Name): PAUL ROBERT SYNOWICKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 108
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 108
SAINT CLOUD FL
34769-4123
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-3387
  • Fax: 407-498-3402
Mailing address:
  • Phone: 407-892-3387
  • Fax: 407-498-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME179310
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34561
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: