Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | OS17947 | FL |
NPI | 1023464054 |
---|---|
Provider Name | Andrea Mccullum Mejia |
First Address | Winter Garden, FL 34787-9556 |
Second Address | Winter Garden, FL 34787-9556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2016 |
Last Update Date | 17/08/2021 |