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Individual

GRACE HYEIWON LEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
3515 E FLETCHER AVE, TAMPA, FL 33613
(813) 974-2201
(813) 974-4325
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
OS15548
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
103371000
FL
01
17S9E
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/03/2014
Last updated
03/31/2021
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