MEDICARE: MICHELLE LE PA-C

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	PA9116850	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760195887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LE PA-C

Provider Business Mailing Address
First Line	:	520 E CHURCH ST APT 1008
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3158
Country	:	US
Telephone Number	:	352-216-6561
Fax Number	:

Provider Business Practice Location Address
First Line	:	5810 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4812
Country	:	US
Telephone Number	:	407-207-0601
Fax Number	:

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

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	02/05/2024

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Directions to “ MICHELLE LE PA-C” Practice Location

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