Healthcare Provider Details

I. General information

NPI: 1851920888
Provider Name (Legal Business Name): ALEXIS MARIE AVELLINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 ORANGE AVE
WINTER PARK FL
32789-4984
US

IV. Provider business mailing address

1285 ORANGE AVE
WINTER PARK FL
32789-4984
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2287
  • Fax: 407-643-2801
Mailing address:
  • Phone: 407-647-2287
  • Fax: 407-643-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberME158296
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME158296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: