Healthcare Provider Details

I. General information

NPI: 1013570894
Provider Name (Legal Business Name): ALEXANDRA LACKEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W FAIRBANKS AVE
WINTER PARK FL
32789-4603
US

IV. Provider business mailing address

1605 W FAIRBANKS AVE
WINTER PARK FL
32789-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-845-8356
  • Fax:
Mailing address:
  • Phone: 407-845-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME146362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: