Healthcare Provider Details

I. General information

NPI: 1659266468
Provider Name (Legal Business Name): JILLIAN MARIE SENNELLO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 HARDEN BLVD UNIT 101
LAKELAND FL
33803-5940
US

IV. Provider business mailing address

4205 N SUWANEE AVE
TAMPA FL
33603-3855
US

V. Phone/Fax

Practice location:
  • Phone: 863-607-9030
  • Fax:
Mailing address:
  • Phone: 561-215-2473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: