Healthcare Provider Details

I. General information

NPI: 1831765155
Provider Name (Legal Business Name): OLIVIA PERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 10/08/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

9230 OAKFAIR DR
TALLAHASSEE FL
32317-8675
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-6132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number114558
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: