Healthcare Provider Details

I. General information

NPI: 1285375865
Provider Name (Legal Business Name): EMILY REBECCA VLASIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

681 W LUMSDEN RD
BRANDON FL
33511-5911
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-7726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME174166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: