MEDICARE: MYA INTERNAL MEDICINE, INC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1417739517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYA INTERNAL MEDICINE, INC

Provider Business Mailing Address
First Line	:	6886 PIAZZA GRANDE AVE APT 1201
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8776
Country	:	US
Telephone Number	:	407-967-1579
Fax Number	:

Provider Business Practice Location Address
First Line	:	6718 LAKE NONA BLVD STE 120
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7984
Country	:	US
Telephone Number	:	321-400-0451
Fax Number	:

Authorized Official
Title or Position	:	INTERNAL MEDICINE DIRECTOR
Name	:	DR. ADALGIZA ELENA COSTA MORON
Credential	:	MD
Telephone Number	:	407-967-1579

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	06/10/2024

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Directions to “MYA INTERNAL MEDICINE, INC ” Practice Location

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