Healthcare Provider Details

I. General information

NPI: 1811788490
Provider Name (Legal Business Name): ELISHA VILDOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 N ORANGE BLOSSOM TRL
ORLANDO FL
32805-1612
US

IV. Provider business mailing address

612 CANNON RIDGE DR APT 2516
ORLANDO FL
32818-6798
US

V. Phone/Fax

Practice location:
  • Phone: 407-428-5751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number33926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: