Healthcare Provider Details

I. General information

NPI: 1922530377
Provider Name (Legal Business Name): DANIEL CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7070
  • Fax:
Mailing address:
  • Phone: 407-646-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberME151032
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME151032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: