Provider Demographics
NPI:1144209669
Name:MEDINA-IRIZARRY, MARISELLY (MD)
Entity Type:Individual
Prefix:
First Name:MARISELLY
Middle Name:
Last Name:MEDINA-IRIZARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 FUTURES DR STE 7
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9076
Mailing Address - Country:US
Mailing Address - Phone:407-219-5936
Mailing Address - Fax:407-480-3455
Practice Address - Street 1:8803 FUTURES DR STE 7
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9076
Practice Address - Country:US
Practice Address - Phone:407-219-5936
Practice Address - Fax:407-480-3455
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93134207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5089WOtherMEDICARE
FLI34698Medicare UPIN