Basic Information
| Provider Information | |||||||||
| NPI: | 1518037944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELLODY | ||||||||
| FirstName: | DANNA | ||||||||
| MiddleName: | COOMES | ||||||||
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| Credential: | PA | ||||||||
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| OtherLastName: | COOMES | ||||||||
| OtherFirstName: | DANNA | ||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 102 W. PINELOCH AVE. | ||||||||
| Address2: | SUITE 23 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074817174 | ||||||||
| FaxNumber: | 4074817190 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 W UNDERWOOD ST | ||||||||
| Address2: | SUITE 200, 2ND FLOOR | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076496884 | ||||||||
| FaxNumber: | 4072457059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 08/20/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA 9102439 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.