Healthcare Provider Details

I. General information

NPI: 1598601411
Provider Name (Legal Business Name): KYLE DRAPEAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15815 SHADDOCK DR STE 130
WINTER GARDEN FL
34787-5773
US

IV. Provider business mailing address

15815 SHADDOCK DR STE 130
WINTER GARDEN FL
34787-5773
US

V. Phone/Fax

Practice location:
  • Phone: 407-605-2321
  • Fax: 407-671-4155
Mailing address:
  • Phone: 407-605-2321
  • Fax: 407-671-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: