Provider Demographics
NPI:1942252689
Name:FAMILY PHYSICIANS OF WINTER PARK
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF WINTER PARK
Other - Org Name:FAMILY PHYSICIANS OF WILLIAMSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NAYANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-293-2930
Mailing Address - Street 1:5454 CENTRAL FLORIDA PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8774
Mailing Address - Country:US
Mailing Address - Phone:407-239-0771
Mailing Address - Fax:407-239-0288
Practice Address - Street 1:6336 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7812
Practice Address - Country:US
Practice Address - Phone:407-447-4283
Practice Address - Fax:407-447-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58522207Q00000X
FLME77880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00174Medicare ID - Type Unspecified