Healthcare Provider Details

I. General information

NPI: 1952821829
Provider Name (Legal Business Name): MY-LIEN THI TRUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MY-LIEN THI NGUYEN MD

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 HARBOR BLVD
PORT CHARLOTTE FL
33952-6720
US

IV. Provider business mailing address

3080 HARBOR BLVD
PORT CHARLOTTE FL
33952-6720
US

V. Phone/Fax

Practice location:
  • Phone: 941-883-2199
  • Fax: 941-979-5041
Mailing address:
  • Phone: 941-883-2199
  • Fax: 941-979-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD-47963
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME159310
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2017016683
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number390200000X
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: