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Specialty details in registry · Orlando, FL

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At a glance

4871 New Broad St, Orlando, FL 32814-6629

NPPES record updated Feb 27, 2019. Public records can lag behind changes at a practice.

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Practice location

4871 New Broad St
Orlando, FL 32814-6629

Professional details: NPI, taxonomy & registry record

NPI1265999189

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 261QI0500X
Enumeration date: Feb 27, 2019
Record updated: Feb 27, 2019

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

261QI0500X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

4871 New Broad St
Orlando, FL 32814-6629

Phone: (321) 947-5618

Mailing address

4871 NEW BROAD ST

ORLANDO, FL 328146629

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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