Provider Demographics
NPI:1912439837
Name:PELLETT, CHRISTENA LYNN (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTENA
Middle Name:LYNN
Last Name:PELLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 E MICHIGAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2700
Mailing Address - Country:US
Mailing Address - Phone:407-456-2977
Mailing Address - Fax:407-745-4688
Practice Address - Street 1:5555 E MICHIGAN ST STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2700
Practice Address - Country:US
Practice Address - Phone:407-456-2977
Practice Address - Fax:407-745-4688
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS17267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program