Provider Demographics
NPI:1386628857
Name:LEE, CHEE Y (MD)
Entity Type:Individual
Prefix:DR
First Name:CHEE
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 N. CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-238-9064
Mailing Address - Fax:386-238-9063
Practice Address - Street 1:1630 N. CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-238-9064
Practice Address - Fax:386-238-9063
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79769207R00000X
ORMD27863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR007107Medicaid
OR007107Medicaid
ORR141229Medicare PIN
OR4280230001Medicare NSC