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1800 Pembrook Dr Ste 300 Orlando FL 32810-6378 | |
| (386) 848-8751 | |
| (866) 401-0161 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1800 Pembrook Dr Ste 300, Orlando, Florida |
| Authorized Official Name and Position | Aliaksandra Regan (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3868488751 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6320 1/2 El Mirando St Austin TX 78741-2412 Ph: (386) 214-9990 | 1800 Pembrook Dr Ste 300 Orlando FL 32810-6378 Ph: (386) 848-8751 |
| NPI Number | 1386372696 |
|---|---|
| Provider Enumeration Date | 08/13/2022 |
| Last Update Date | 05/18/2023 |
| Certification Date | 05/18/2023 |
| Medicare PECOS PAC ID | 0143687210 |
|---|---|
| Medicare Enrollment ID | O20230605002196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386372696 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363AM0700X | Physician Assistant - Medical | (* (Not Available)) | Secondary |
| Provider Name | Melissa L Dipaolis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447346184 PECOS PAC ID: 5698774263 Enrollment ID: I20061208000027 |
| Provider Name | Marjorie Felix |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851083588 PECOS PAC ID: 3870941131 Enrollment ID: I20231127002146 |
| Provider Name | Toni Cassidy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710733662 PECOS PAC ID: 7618419078 Enrollment ID: I20240613000300 |
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