Healthcare Provider Details

I. General information

NPI: 1598677304
Provider Name (Legal Business Name): ILEANA NILES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ILEANA RAMOS MD

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 PEACEFUL CIR
SANFORD FL
32771-8240
US

IV. Provider business mailing address

8019 PEACEFUL CIR
SANFORD FL
32771-8240
US

V. Phone/Fax

Practice location:
  • Phone: 817-396-0924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME74900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: