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General NPI Number Information
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NPI Number | 1174083307
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Entity Type | Individual
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Provider Name | KAYLA RACQUEL DESUZA DO
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Gender | Female
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 7472 DOCS GROVE CIR
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City | ORLANDO
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State | FL
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Zip | 32819-8010
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Country | US
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Telephone | 407-241-1037
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Fax | 321-842-7966
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Provider Business Mailing Address
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Address Line | 5301 S CONGRESS AVE
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City | ATLANTIS
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State | FL
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Zip | 33462-1149
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Country | US
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Telephone | 561-548-1450
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Fax | 561-548-1459
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | OS21723
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License Number State | FL
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