MEDICARE: ELENA PHAM

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	2084P0800X	Psychiatry Physician	TRN40580	FL

General Provider Information

NPI Number	:	1073372637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA PHAM

Provider Business Mailing Address
First Line	:	720 W OAK ST STE 201
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4998
Country	:	US
Telephone Number	:	407-518-2703
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 W OAK ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4989
Country	:	US
Telephone Number	:	407-518-2703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	06/22/2026

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Directions to “ ELENA PHAM ” Practice Location

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