MEDICARE: DR. JULIA VANDER WEIDE MD

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	ME172706	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	4301503215	MI
3	2084P0804X	Child & Adolescent Psychiatry Physician	ME172706	FL
4	2084P0800X	Psychiatry Physician	4301503215	MI

General Provider Information

NPI Number	:	1275064511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA VANDER WEIDE MD

Provider Business Mailing Address
First Line	:	1483 LAKE BALDWIN LN APT A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6744
Country	:	US
Telephone Number	:	407-236-4172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1483 LAKE BALDWIN LN APT A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6744
Country	:	US
Telephone Number	:	407-236-4172
Fax Number	:

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

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	10/28/2025

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