Provider Demographics
NPI:1699025064
Name:KEFFER MACHADO, REBECCA ANNE (LM,CPM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:KEFFER MACHADO
Suffix:
Gender:F
Credentials:LM,CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S ORLANDO AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5543
Mailing Address - Country:US
Mailing Address - Phone:321-316-4726
Mailing Address - Fax:407-513-4328
Practice Address - Street 1:1400 S ORLANDO AVE STE 320
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5543
Practice Address - Country:US
Practice Address - Phone:321-316-4726
Practice Address - Fax:407-513-4328
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW266176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009454900Medicaid