MR. DEMITTRE ANDRE ANTHONY SORENSON PA-C NPI 1881264455

NPI Information

NPI: 1881264455
Provider Name: MR. DEMITTRE ANDRE ANTHONY SORENSON, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
740 CONCOURSE PKWY S STE 200
MAITLAND, FL
ZIP 32751
Phone: (407) 644-4014
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MR. Demittre Andre Anthony Sorenson, PA-C is a medical physician assistant in Maitland, FL with 3 years of experience. MR. Demittre Andre Anthony Sorenson, PA-C NPI is 1881264455. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

740 CONCOURSE PKWY S STE 200
MAITLAND, FL
ZIP 32751-101
Phone: (407) 644-4014

The NPI 1881264455 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/28/2021 and was last updated on 9/6/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program				No
2	363AM0700X	Physician Assistant	Medical	PA9114808	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	111483000	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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