MEDICARE: EAR, NOSE, THROAT ASSOCIATES OF ORLANDO, PLLC

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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1871048736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAR, NOSE, THROAT ASSOCIATES OF ORLANDO, PLLC

Provider Business Mailing Address
First Line	:	1035 N ORLANDO AVE
Second Line	:	STE#205
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2213
Country	:	US
Telephone Number	:	407-636-5384
Fax Number	:	407-636-5385

Provider Business Practice Location Address
First Line	:	1035 N ORLANDO AVE
Second Line	:	STE#205
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2213
Country	:	US
Telephone Number	:	407-636-5384
Fax Number	:	407-636-5385

Authorized Official
Title or Position	:	CREDENTAILING COORDINATOR
Name	:	JULIA CHUMBLEY
Credential	:
Telephone Number	:	904-685-8545

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	07/21/2022

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