Provider Demographics
NPI:1053655878
Name:MARSHAM, LYDIA KARLYN (PA - C)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:KARLYN
Last Name:MARSHAM
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:460 E ALTAMONTE DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4653
Mailing Address - Country:US
Mailing Address - Phone:407-435-3636
Mailing Address - Fax:
Practice Address - Street 1:460 E ALTAMONTE DR STE 2200
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4653
Practice Address - Country:US
Practice Address - Phone:407-767-0009
Practice Address - Fax:407-767-0022
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103622363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical