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General NPI Number Information
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NPI Number | 1639876733
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Entity Type | Organization
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Legal Business Name | PELHAM MEDICAL CONSULTING & AESTHETIC LOUNGE, LLC.
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 5979 VINELAND RD STE 207
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City | ORLANDO
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State | FL
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Zip | 32819-7855
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Country | US
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Telephone | 407-893-1181
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Fax | 407-440-8269
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Provider Business Mailing Address
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Address Line | 5979 VINELAND RD STE 207
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City | ORLANDO
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State | FL
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Zip | 32819-7855
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Country | US
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Telephone | 407-893-1181
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Fax | 407-440-8269
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Authorized Official
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Title or Position | OWNER
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Name | JANADRA DEAN GREENIDGE
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Credential | NP
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Telephone | 407-893-1181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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