Healthcare Provider Details

I. General information

NPI: 1811947864
Provider Name (Legal Business Name): SYLVIA M. SANTIAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLVIA M. SANTIAGO-RODRIGUEZ

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14254 MARTIN LUTHER KING BLVD
DOVER FL
33527-4414
US

IV. Provider business mailing address

13110 ELK MOUNTAIN DR
RIVERVIEW FL
33579-7182
US

V. Phone/Fax

Practice location:
  • Phone: 813-349-7700
  • Fax: 813-938-6422
Mailing address:
  • Phone: 813-349-7569
  • Fax: 813-349-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME95294
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: