Provider Demographics
NPI:1518037944
Name:VELLODY, DANNA COOMES (PA)
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:COOMES
Last Name:VELLODY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DANNA
Other - Middle Name:
Other - Last Name:COOMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:102 W. PINELOCH AVE.
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-481-7174
Mailing Address - Fax:407-481-7190
Practice Address - Street 1:77 W UNDERWOOD ST
Practice Address - Street 2:SUITE 200, 2ND FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-649-6884
Practice Address - Fax:407-245-7059
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9102439363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1948ZMedicare Oscar/Certification
FLQ06110Medicare UPIN