Healthcare Provider Details

I. General information

NPI: 1851092027
Provider Name (Legal Business Name): MASON VILARDO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 MACK BAYOU RD
SANTA ROSA BEACH FL
32459-3104
US

IV. Provider business mailing address

1401 REED CANAL RD UNIT 17203
PORT ORANGE FL
32129-9491
US

V. Phone/Fax

Practice location:
  • Phone: 513-474-7378
  • Fax: 877-775-2232
Mailing address:
  • Phone: 513-474-7378
  • Fax: 877-775-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDC-05247
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05247
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: