=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265545933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYLLETTE KING MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 02/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 S CHICKASAW TRL SUITE 100
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32825-7833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-828-8775
-----------------------------------------------------
Fax | 407-282-0886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 506 S CHICKASAW TRL SUITE 100
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32825-7833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-828-8775
-----------------------------------------------------
Fax | 407-282-0886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | QWNER
-----------------------------------------------------
Name | SYLLETTE KING
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-282-8776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | ME69026
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------