Provider Demographics
NPI:1902450661
Name:ISIDOR, DOROTHY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:ISIDOR
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13431 CARROWAY ST
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7344
Mailing Address - Country:US
Mailing Address - Phone:321-947-6159
Mailing Address - Fax:
Practice Address - Street 1:2984 ALAFAYA TRL STE 1030
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7628
Practice Address - Country:US
Practice Address - Phone:407-542-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant