Provider Demographics
NPI:1609884253
Name:REINU, REELI (PA)
Entity Type:Individual
Prefix:
First Name:REELI
Middle Name:
Last Name:REINU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 PARK CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6256
Mailing Address - Country:US
Mailing Address - Phone:407-445-9445
Mailing Address - Fax:407-293-3908
Practice Address - Street 1:2600 LAKE LUCIEN DR STE 180
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7235
Practice Address - Country:US
Practice Address - Phone:407-875-2080
Practice Address - Fax:407-875-0518
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP68271Medicare UPIN
FLE81522Medicare ID - Type Unspecified