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General NPI Number Information
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NPI Number | 1811862352
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Entity Type | Individual
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Provider Name | VINITA MENON
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Gender | Female
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 2415 N ORANGE AVE STE 200
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City | ORLANDO
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State | FL
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Zip | 32804-5505
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Country | US
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Telephone | 407-303-1812
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Fax |
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Provider Business Mailing Address
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Address Line | 305 MEDIO DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-6717
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Country | US
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Telephone |
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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 | PA9120986
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License Number State | FL
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