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2863 S Delaney Ave Orlando FL 32806-5412 | |
| (407) 843-1620 | |
| (407) 843-5243 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 2863 S Delaney Ave, Orlando, Florida |
| Authorized Official Name and Position | Kim Fraticelli (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 4079927740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2863 Delaney Ave Orlando FL 32806-5412 Ph: (407) 843-1620 | 2863 S Delaney Ave Orlando FL 32806-5412 Ph: (407) 843-1620 |
| NPI Number | 1013967306 |
|---|---|
| Provider Enumeration Date | 05/10/2006 |
| Last Update Date | 08/14/2024 |
| Medicare PECOS PAC ID | 1456357664 |
|---|---|
| Medicare Enrollment ID | O20061011000551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013967306 | NPI | - | NPPES |
| 38240 | Other | FL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Cristina P Garcia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003841495 PECOS PAC ID: 0042216608 Enrollment ID: I20061005000037 |
| Provider Name | Richard H Janovitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437126174 PECOS PAC ID: 1355347568 Enrollment ID: I20061027000288 |
| Provider Name | Jan C Parrillo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275500951 PECOS PAC ID: 2264438472 Enrollment ID: I20061027000295 |
| Provider Name | Edmund F Delgado |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346217080 PECOS PAC ID: 4981600194 Enrollment ID: I20061027000299 |
| Provider Name | Mitul N Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700086048 PECOS PAC ID: 8123192614 Enrollment ID: I20140923001154 |
| Provider Name | Shana M Caldwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578166971 PECOS PAC ID: 6204241912 Enrollment ID: I20210210001892 |
| Provider Name | Jumana Al-deek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710477047 PECOS PAC ID: 3577997139 Enrollment ID: I20210817004199 |
| Provider Name | Nathan Henry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497370506 PECOS PAC ID: 5496178642 Enrollment ID: I20230805000145 |
| Provider Name | Jennifer Lim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881478907 PECOS PAC ID: 9436508223 Enrollment ID: I20231205002047 |
| Provider Name | Brett Jordan Devoursney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336713171 PECOS PAC ID: 3072914530 Enrollment ID: I20240711001534 |
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