Healthcare Provider Details

I. General information

NPI: 1154707180
Provider Name (Legal Business Name): ELIZABETH MUDDIMAN CEFALU MD MPH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2572 COMMERCE PKWY
NORTH PORT FL
34289-9332
US

IV. Provider business mailing address

2572 COMMERCE PKWY
NORTH PORT FL
34289-9332
US

V. Phone/Fax

Practice location:
  • Phone: 941-888-5839
  • Fax: 941-888-5840
Mailing address:
  • Phone: 941-888-5839
  • Fax: 941-888-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MUDDIMAN CEFALU
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 941-806-8920