Provider Demographics
NPI:1548993025
Name:RICHARDSON, PAMELA MICHELLE (DO)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MICHELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1745
Mailing Address - Country:US
Mailing Address - Phone:407-422-5310
Mailing Address - Fax:407-423-9021
Practice Address - Street 1:1800 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1745
Practice Address - Country:US
Practice Address - Phone:407-422-5310
Practice Address - Fax:407-423-9021
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38-4206980Other253Z00000X