Provider Demographics
NPI:1194351197
Name:FERNANDES E MAGALHAES SANTOS, KAYO HENRIQUE
Entity type:Individual
Prefix:
First Name:KAYO HENRIQUE
Middle Name:
Last Name:FERNANDES E MAGALHAES SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 S SEMORAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2472
Mailing Address - Country:US
Mailing Address - Phone:407-203-8957
Mailing Address - Fax:
Practice Address - Street 1:4445 S SEMORAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2472
Practice Address - Country:US
Practice Address - Phone:407-203-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160443208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics