MEDICARE: VIVIAN NG

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	2255A2300X	Athletic Trainer	AL7458	FL

General Provider Information

NPI Number	:	1376393769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN NG

Provider Business Mailing Address
First Line	:	4030 TOWNSHIP SQUARE BLVD APT 711
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-5383
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 TOWNSHIP SQUARE BLVD APT 711
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-5383
Country	:	US
Telephone Number	:	407-749-4973
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	05/21/2025

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Directions to “ VIVIAN NG ” Practice Location

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