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General NPI Number Information
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NPI Number | 1497922819
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Entity Type | Individual
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Provider Name | TADEJA AGEE MD
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Gender | Female
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 901 N LAKE DESTINY RD SUITE 400
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City | MAITLAND
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State | FL
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Zip | 32751-4844
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Country | US
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Telephone | 407-200-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 LAKE BALDWIN LN #315
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City | ORLANDO
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State | FL
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Zip | 32814-6761
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Country | US
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Telephone | 704-995-0185
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12345
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME117131
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License Number State | FL
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