Basic Information
Provider Information
NPI: 1801418371
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: HELEN
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1222 S ORANGE AVE
Address2:  
City: ORLANDO
State: FL
PostalCode: 328061215
CountryCode: US
TelephoneNumber: 3218416444
FaxNumber: 4076501307
Practice Location
Address1: 1222 S ORANGE AVE
Address2:  
City: ORLANDO
State: FL
PostalCode: 328061215
CountryCode: US
TelephoneNumber: 3218416444
FaxNumber: 4076501307
Other Information
ProviderEnumerationDate: 05/07/2020
LastUpdateDate: 12/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  N Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363AM0700XPA9113227FLY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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