Individual
STHORN THATAYATIKOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3000 N ORANGE AVE STE DE, ORLANDO, FL 32804-7613
(407) 845-8342
(407) 845-8343
Mailing address
PO BOX 191, PROVIDER ENROLLMENT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
ME114556
FL
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
ME114556
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007647400
—
FL
Enumeration date
04/28/2008
Last updated
11/21/2023
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