Healthcare Provider Details

I. General information

NPI: 1992736565
Provider Name (Legal Business Name): ORLANDO JOSEPH CICILIONI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 209
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

PO BOX 8670
LONGBOAT KEY FL
34228-8670
US

V. Phone/Fax

Practice location:
  • Phone: 407-681-3223
  • Fax: 407-681-0976
Mailing address:
  • Phone: 941-388-1110
  • Fax: 941-388-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0065746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: