Basic Information
Provider Information
NPI: 1003298779
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REYES ARNALDY
FirstName: AMY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1749 DAVID WALKER DR
Address2:  
City: TAVARES
State: FL
PostalCode: 327785745
CountryCode: US
TelephoneNumber: 3523430181
FaxNumber: 3523430812
Practice Location
Address1: 1749 DAVID WALKER DR
Address2:  
City: TAVARES
State: FL
PostalCode: 327785745
CountryCode: US
TelephoneNumber: 3523430181
FaxNumber: 3523430812
Other Information
ProviderEnumerationDate: 06/18/2015
LastUpdateDate: 08/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/19/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X293514NYN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XME145367FLN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RG0300XME145367FLY Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine

No ID Information.


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