Healthcare Provider Details

I. General information

NPI: 1699025064
Provider Name (Legal Business Name): REBECCA ANNE KEFFER MACHADO LM,CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORLANDO AVE STE 320
WINTER PARK FL
32789-5543
US

IV. Provider business mailing address

1400 S ORLANDO AVE STE 320
WINTER PARK FL
32789-5543
US

V. Phone/Fax

Practice location:
  • Phone: 321-316-4726
  • Fax: 407-513-4328
Mailing address:
  • Phone: 321-316-4726
  • Fax: 407-513-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: