Healthcare Provider Details

I. General information

NPI: 1164316816
Provider Name (Legal Business Name): CASSY MEGAN LOUIS ARCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. CASSY MEGAN LOUIS

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
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

2650 DADE AVE APT 1310
ORLANDO FL
32804-4636
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7757
  • Fax: 407-646-7775
Mailing address:
  • Phone: 347-824-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: