Healthcare Provider Details

I. General information

NPI: 1639817620
Provider Name (Legal Business Name): JANNELYS AVILES AGUILAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 E STATE ROAD 434 UNIT 3037
LONGWOOD FL
32750-5256
US

IV. Provider business mailing address

587 E STATE ROAD 434 UNIT 3037
LONGWOOD FL
32750-5256
US

V. Phone/Fax

Practice location:
  • Phone: 352-935-1136
  • Fax:
Mailing address:
  • Phone: 352-935-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: