Basic Information
| Provider Information | |||||||||
| NPI: | 1962047670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONDEK | ||||||||
| FirstName: | ANNAMARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 434 LUNA BELLA LN APT 332 | ||||||||
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| City: | NEW SMYRNA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321684522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407104831 | ||||||||
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| Practice Location | |||||||||
| Address1: | 305 MEMORIAL MEDICAL PKWY STE 206 | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321175169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073847388 | ||||||||
| FaxNumber: | 4073841140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2019 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 9112758 | FL | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 363A00000X | PA9112758 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.