Provider Demographics
NPI:1881555456
Name:MC INNIS MENESES, FELIPE ELIAS (PA)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:ELIAS
Last Name:MC INNIS MENESES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4818
Mailing Address - Country:US
Mailing Address - Phone:689-316-4933
Mailing Address - Fax:
Practice Address - Street 1:1344 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4818
Practice Address - Country:US
Practice Address - Phone:689-316-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-316246ZC0007X
PR2876-P.A.363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical