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General NPI Number Information
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NPI Number | 1285566703
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Entity Type | Individual
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Provider Name | LISETH GRAHAM P.A.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 851 BREVARD CT
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City | ORLANDO
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State | FL
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Zip | 32822-8118
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Country | US
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Telephone | 646-920-8937
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Fax |
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Provider Business Mailing Address
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Address Line | 851 BREVARD CT
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City | ORLANDO
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State | FL
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Zip | 32822-8118
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Country | US
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Telephone | 646-920-8937
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 25-499
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3180-P.A.
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3180-P.A.
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License Number State | PR
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