Healthcare Provider Details

I. General information

NPI: 1104706142
Provider Name (Legal Business Name): MICHELLE MARIE CILLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

IV. Provider business mailing address

1240 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

V. Phone/Fax

Practice location:
  • Phone: 561-263-2234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: