Healthcare Provider Details

I. General information

NPI: 1871048736
Provider Name (Legal Business Name): EAR, NOSE, THROAT ASSOCIATES OF ORLANDO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 N ORLANDO AVE STE#205
WINTER PARK FL
32789-2213
US

IV. Provider business mailing address

1035 N ORLANDO AVE STE#205
WINTER PARK FL
32789-2213
US

V. Phone/Fax

Practice location:
  • Phone: 407-636-5384
  • Fax: 407-636-5385
Mailing address:
  • Phone: 407-636-5384
  • Fax: 407-636-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIA CHUMBLEY
Title or Position: CREDENTAILING COORDINATOR
Credential:
Phone: 904-685-8545