MEDICARE: MRS. LEVENIA PHILLS

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	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1356146179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEVENIA PHILLS

Provider Business Mailing Address
First Line	:	19346 MARDI GRAS ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32833-3011
Country	:	US
Telephone Number	:	347-778-8577
Fax Number	:

Provider Business Practice Location Address
First Line	:	19346 MARDI GRAS ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32833-3011
Country	:	US
Telephone Number	:	347-778-8577
Fax Number	:

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

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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