Healthcare Provider Details

I. General information

NPI: 1285308957
Provider Name (Legal Business Name): EMILIO SANCHEZ-MEDINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 BUDINGER AVE
SAINT CLOUD FL
34769-4157
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-9890
  • Fax: 407-910-4795
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11014289
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: