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1954 Howell Branch Rd Winter Park FL 32792-1041 | |
| (407) 917-6015 | |
| (949) 437-8401 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1954 Howell Branch Rd, Winter Park, Florida |
| Authorized Official Name and Position | Anamaria Shanley (NURSE PRACTITIONER/ OWNER) |
| Authorized Official Contact | 4079176015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3564 Avalon Park East Blvd Ste 110 Orlando FL 32828-7365 Ph: (407) 917-6015 | 1954 Howell Branch Rd Winter Park FL 32792-1041 Ph: (407) 917-6015 |
| NPI Number | 1386369700 |
|---|---|
| Provider Enumeration Date | 10/07/2022 |
| Last Update Date | 03/06/2023 |
| Certification Date | 03/06/2023 |
| Medicare PECOS PAC ID | 4183090392 |
|---|---|
| Medicare Enrollment ID | O20221012003925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386369700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Anamaria Gonzalez Shanley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871539361 PECOS PAC ID: 0648285528 Enrollment ID: I20060214000339 |
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