Healthcare Provider Details

I. General information

NPI: 1992974463
Provider Name (Legal Business Name): SYLVESTER AJUFO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 SW 22ND PL
OCALA FL
34471-7766
US

IV. Provider business mailing address

2131 SW 22ND PL
OCALA FL
34471-7766
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-3700
  • Fax: 352-369-3931
Mailing address:
  • Phone: 352-369-3700
  • Fax: 352-369-3931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME77338
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberME77338
License Number StateFL

VIII. Authorized Official

Name: PATRICIA I AJUFO
Title or Position: OFFICE MANAGER
Credential:
Phone: 352-369-3700