Provider Demographics
NPI:1265554380
Name:CUTILLAR, LYNDON (PA-C)
Entity type:Individual
Prefix:
First Name:LYNDON
Middle Name:
Last Name:CUTILLAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10743 NARCOOSSEE RD
Mailing Address - Street 2:STE A18
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6947
Mailing Address - Country:US
Mailing Address - Phone:407-277-1900
Mailing Address - Fax:
Practice Address - Street 1:6388 SILVER STAR RD
Practice Address - Street 2:SUITE C1
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3235
Practice Address - Country:US
Practice Address - Phone:407-522-5311
Practice Address - Fax:407-292-5292
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103647363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013331200Medicaid
FLAD315XMedicare PIN