Healthcare Provider Details

I. General information

NPI: 1942821343
Provider Name (Legal Business Name): ALEJANDRO PELAEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 201
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

8 BERRY LN
HICKSVILLE NY
11801-6204
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7757
  • Fax:
Mailing address:
  • Phone: 516-450-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME158034
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPENDING
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: