Healthcare Provider Details

I. General information

NPI: 1154586972
Provider Name (Legal Business Name): MARILYN LLAVONA-SUAREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILYN LLAVONA MD

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10621 WITTENBERG WAY
ORLANDO FL
32832-7028
US

IV. Provider business mailing address

10621 WITTENBERG WAY
ORLANDO FL
32832-7028
US

V. Phone/Fax

Practice location:
  • Phone: 407-994-4606
  • Fax: 888-338-4430
Mailing address:
  • Phone: 407-994-4606
  • Fax: 888-338-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17207
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: