Healthcare Provider Details

I. General information

NPI: 1164461810
Provider Name (Legal Business Name): NINA ANN CAVALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CELEBRATION BLVD STE 301
CELEBRATION FL
34747-5165
US

IV. Provider business mailing address

5027 VANTAGE CT
SAINT CLOUD FL
34772-7564
US

V. Phone/Fax

Practice location:
  • Phone: 407-566-9700
  • Fax: 407-566-9700
Mailing address:
  • Phone: 201-693-7034
  • Fax: 201-768-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME143314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: