Healthcare Provider Details

I. General information

NPI: 1396277257
Provider Name (Legal Business Name): ASHLEY MARIE CILIBERTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 08/30/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 BROWNSBORO RD STE 101
LOUISVILLE KY
40241-1125
US

IV. Provider business mailing address

9800 SHELBYVILLE RD STE 220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 502-618-3740
  • Fax: 502-429-6157
Mailing address:
  • Phone: 502-429-8585
  • Fax: 855-656-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036.152900
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number01087725A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBF4649604-C356
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number56689
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: