Healthcare Provider Details

I. General information

NPI: 1194493346
Provider Name (Legal Business Name): PEDIATRICS OF CENTRAL FLORIDA P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 17TH ST
SAINT CLOUD FL
34769-6011
US

IV. Provider business mailing address

801 W OAK ST STE 101
KISSIMMEE FL
34741-6605
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-0479
  • Fax: 407-891-8775
Mailing address:
  • Phone: 407-846-3455
  • Fax: 407-846-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RUPA DESAI
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-846-3455