Healthcare Provider Details

I. General information

NPI: 1982937520
Provider Name (Legal Business Name): MICHELLE A. PEREZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S LAKEMONT AVE
WINTER PARK FL
32792-5496
US

IV. Provider business mailing address

200 SAINT ANDREWS BLVD APT 2105
WINTER PARK FL
32792-4245
US

V. Phone/Fax

Practice location:
  • Phone: 407-222-3210
  • Fax:
Mailing address:
  • Phone: 407-222-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA 12260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: