MEDICARE: MR. MICHAEL T SIINO PAC

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	363AM0700X	Medical Physician Assistant	PA3235	FL

General Provider Information

NPI Number	:	1518957984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL T SIINO PAC

Provider Business Mailing Address
First Line	:	600 VILLAGE SQUARE XING
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4543
Country	:	US
Telephone Number	:	561-693-0540
Fax Number	:	561-296-6174

Provider Business Practice Location Address
First Line	:	7605 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-2646
Country	:	US
Telephone Number	:	321-732-8150
Fax Number	:	407-613-5915

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	01/05/2021

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