Healthcare Provider Details

I. General information

NPI: 1659254456
Provider Name (Legal Business Name): CELEBRATION ORTHOPEDIC AND SPORTS MEDICINE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6718 LAKE NONA BLVD STE 110
ORLANDO FL
32827-7984
US

IV. Provider business mailing address

2954 MALLORY CIR STE 101
CELEBRATION FL
34747-1822
US

V. Phone/Fax

Practice location:
  • Phone: 321-939-0222
  • Fax:
Mailing address:
  • Phone: 321-939-0222
  • Fax: 321-939-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ENEIDA CARRASQUILLO
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 321-939-0222