Provider Demographics
NPI:1447520358
Name:TRIANTAFELLU, JAMIE LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LEE
Last Name:TRIANTAFELLU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 KEARIN LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5811
Mailing Address - Country:US
Mailing Address - Phone:407-670-8648
Mailing Address - Fax:
Practice Address - Street 1:3235 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3723
Practice Address - Country:US
Practice Address - Phone:407-649-7859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist