Healthcare Provider Details

I. General information

NPI: 1326861121
Provider Name (Legal Business Name): JOSEPH SIVOLI CRPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 EDGEWATER DR
ORLANDO FL
32804-6815
US

IV. Provider business mailing address

1702 BAXTER AVE
ORLANDO FL
32806-6412
US

V. Phone/Fax

Practice location:
  • Phone: 407-676-4068
  • Fax:
Mailing address:
  • Phone: 414-241-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPS.0101636.A
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: