MEDICARE: RILEY DIETER

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	363A00000X	Physician Assistant	PA9120605	FL

General Provider Information

NPI Number	:	1578350385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY DIETER

Provider Business Mailing Address
First Line	:	776 N ORANGE AVE APT 5401
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-7323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N ORANGE AVE STE 201
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4641
Country	:	US
Telephone Number	:	407-821-3620
Fax Number	:	407-321-3621

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

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	06/03/2026

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Directions to “ RILEY DIETER ” Practice Location

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