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General NPI Number Information
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NPI Number | 1528198546
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Entity Type | Individual
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Provider Name | CAROLYN DEWALDEN P.A.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10131 W COLONIAL DR SUITE 4
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City | OCOEE
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State | FL
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Zip | 34761-4221
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Country | US
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Telephone | 407-298-4910
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Fax | 407-296-2638
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Provider Business Mailing Address
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Address Line | 605 STRIHAL LOOP
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City | OAKLAND
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State | FL
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Zip | 34787-8958
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Country | US
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Telephone | 407-877-0984
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9102038
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License Number State | FL
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