Provider Demographics
NPI:1689093379
Name:HENDERSON, MATTHEW BRANDON (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRANDON
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 589
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4647
Mailing Address - Country:US
Mailing Address - Phone:407-303-2080
Mailing Address - Fax:407-303-2085
Practice Address - Street 1:2501 N ORANGE AVE STE 589
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4647
Practice Address - Country:US
Practice Address - Phone:407-303-2080
Practice Address - Fax:407-303-2085
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012742208000000X
FLOS170192080P0207X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics