Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Roberto A Nicodemo, PA

Individual provider Physician Assistant · NPI 1831112416

Roberto A Nicodemo, PA is a Physician Assistant in Kissimmee, Florida. Qualified in 1990, 36 years ago. Practices with Heisu Research Group LLC, a 5-clinician group. Licensed in Florida.

Years since qualifying
36
Licensed in
FL
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1044 Plaza Dr
Kissimmee, FL 34743-4064
Phone: (407) 350-5659
Fax: (407) 350-5662
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9101023 (FL)

Record details

NPI number1831112416
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJuly 25, 2006
Last updated in NPPESFebruary 9, 2024
Certification dateFebruary 9, 2024
Mailing address6675 Westwood Blvd Ste 475, Orlando, FL 32821-6027

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1990 (36 years in practice)
Group practice Heisu Research Group Llc — 5 clinicians
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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