MEDICARE: EVOYENT HEALTH FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1003311267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOYENT HEALTH FOUNDATION

Provider Business Mailing Address
First Line	:	8297 CHAMPIONS GATE BLVD # 446
Second Line	:
City	:	CHAMPIONS GATE
State	:	FL
Zip	:	33896-8387
Country	:	US
Telephone Number	:	321-282-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 S ORANGE AVE STE 900
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-5008
Country	:	US
Telephone Number	:	321-282-1999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SHANA FAIR
Credential	:
Telephone Number	:	321-282-1999

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	03/28/2018

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Directions to “EVOYENT HEALTH FOUNDATION ” Practice Location

Language	Start Address	Practice Location

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