Healthcare Provider Details

I. General information

NPI: 1588661664
Provider Name (Legal Business Name): BORYS A MASCARENHAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 NIGHTINGALE LN STE B4
TAVARES FL
32778-4363
US

IV. Provider business mailing address

PO BOX 558
MOUNT DORA FL
32756-0558
US

V. Phone/Fax

Practice location:
  • Phone: 352-742-2286
  • Fax: 352-742-2289
Mailing address:
  • Phone: 352-742-2286
  • Fax: 352-742-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME85389
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME85389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: