Provider Demographics
NPI:1801998216
Name:PEDROSA, EVELYN JUDITH (MD)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:JUDITH
Last Name:PEDROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 WEST GORE STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-422-2255
Mailing Address - Fax:407-839-4659
Practice Address - Street 1:100 WEST GORE STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-422-2255
Practice Address - Fax:407-839-4659
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 79839208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263340000Medicaid
FL263340000Medicaid