Healthcare Provider Details

I. General information

NPI: 1255003604
Provider Name (Legal Business Name): AMY CHAN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S SEMORAN BLVD
WINTER PARK FL
32792-5313
US

IV. Provider business mailing address

14489 W MEADOW CREEK DR
BOISE ID
83713-2036
US

V. Phone/Fax

Practice location:
  • Phone: 407-961-6561
  • Fax:
Mailing address:
  • Phone: 208-608-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: