Provider Demographics
NPI:1447212295
Name:PENA-SANCHEZ, ORLY (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLY
Middle Name:
Last Name:PENA-SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ORLANDO
Other - Middle Name:DE JESUS
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5150 NW MILNER DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3392
Mailing Address - Country:US
Mailing Address - Phone:772-462-3800
Mailing Address - Fax:772-462-3865
Practice Address - Street 1:1507 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3214
Practice Address - Country:US
Practice Address - Phone:954-514-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15997208D00000X
FLACN232208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI50271Medicare UPIN
FLAP612ZMedicare PIN