MEDICARE: GUYATHRI MYLINEE SIVOTHAYAN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN11026259	FL
2	163W00000X	Registered Nurse	RN9467689	FL

General Provider Information

NPI Number	:	1588350326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUYATHRI MYLINEE SIVOTHAYAN FNP-C

Provider Business Mailing Address
First Line	:	15502 STONEYBROOK WEST PKWY STE 104-245
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4767
Country	:	US
Telephone Number	:	786-451-8048
Fax Number	:

Provider Business Practice Location Address
First Line	:	861 OAKLEY SEAVER DR STE B
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-1968
Country	:	US
Telephone Number	:	813-230-3778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2023
Last Update Date	:	02/17/2026

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