Winter Park Family Practice LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WINTER PARK FAMILY PRACTICE LLC

Doing business as

Family Practice of Winter Park

Practice address

541 S Orlando Ave Ste 204
Maitland, FL 32751-5669

Phone

(407) 647-4008

Fax

(407) 647-3207

NPI assigned

Jan 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Varesh R Patel, DONPI 1760461289

Title

Owner

Phone

(407) 647-4008

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Practice of Winter Park Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Varesh R Patel, DO

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1760461289
  Medicare reassignment NPD Authorized official
• Lindsay Rae Piet, PA-C

  • Medical Physician Assistant
  • Maitland, FL
  • NPI 1922485473
  NPD
• Tully T. Blalock Jr., MD

  • Internal Medicine Physician
  • Rockledge, FL
  • NPI 1417004359
  NPD (past)
• Anthony E Douglas, MD

  • Internal Medicine Physician
  • Maitland, FL
  • NPI 1639122831
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738713600000",
    "number": "1740268929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 S ORLANDO AVE STE 204",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515669",
            "telephone_number": "407-647-4008",
            "fax_number": "407-647-3207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 S ORLANDO AVE STE 204",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515669",
            "telephone_number": "407-647-4008",
            "fax_number": "407-647-3207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINTER PARK FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "VARESH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-647-4008",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DQ6581",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Practice of Winter Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mikayla Wilson
• Shaynia Renea Wilson
• Vance Edward Wilson, C.R.N.A.
• Tara Winn, MSW
• Winter Park Complementary Medicine
• Winter Park Operating Investments LLC
• Robert P Winter, MD
• Devyn Lee Wipperfurth, DC
• Amy Elise Witt, MD
• Katherine Wittenmyer, LMHC

• Family Medicine Physician in Maitland, FL
• Providers in Maitland, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.