Healthcare Provider Details

I. General information

NPI: 1609224740
Provider Name (Legal Business Name): OVIANNY NATALIE SILVERIO CASILLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 S GOLDENROD RD
ORLANDO FL
32822-8108
US

IV. Provider business mailing address

690 S GOLDENROD RD
ORLANDO FL
32822-8108
US

V. Phone/Fax

Practice location:
  • Phone: 407-792-1144
  • Fax: 407-232-9807
Mailing address:
  • Phone: 407-792-1144
  • Fax: 407-232-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME165999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: