Healthcare Provider Details

I. General information

NPI: 1275096612
Provider Name (Legal Business Name): ANLYS OLIVERA MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST STE 609
MIAMI FL
33136-2117
US

IV. Provider business mailing address

1150 NW 14TH ST STE 609
MIAMI FL
33136-2117
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3100
  • Fax: 305-243-4678
Mailing address:
  • Phone: 305-243-3100
  • Fax: 305-243-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME180676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: