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General NPI Number Information
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NPI Number | 1922696129
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Entity Type | Individual
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Provider Name | PHUONG LY
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Gender | Female
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1717 S ORANGE AVE STE 103
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City | ORLANDO
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State | FL
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Zip | 32806-2946
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Country | US
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Telephone | 321-841-3444
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Fax | 321-843-1753
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Provider Business Mailing Address
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Address Line | 1717 S ORANGE AVE STE 103
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City | ORLANDO
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State | FL
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Zip | 32806-2946
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Country | US
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Telephone | 321-841-3444
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Fax | 321-843-1753
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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 | PA9116750
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License Number State | FL
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