Healthcare Provider Details

I. General information

NPI: 1457064933
Provider Name (Legal Business Name): ENEL VILDOR PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N WESTMONTE DR STE 105
ALTAMONTE SPRINGS FL
32714-3345
US

IV. Provider business mailing address

775 CASCADING CREEK LN
WINTER GARDEN FL
34787-5911
US

V. Phone/Fax

Practice location:
  • Phone: 689-349-0560
  • Fax:
Mailing address:
  • Phone: 407-461-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11023575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: