Healthcare Provider Details

I. General information

NPI: 1164000659
Provider Name (Legal Business Name): ANNE ELIZABETH SERRAO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE L200
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST STE L200
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2020
  • Fax:
Mailing address:
  • Phone: 937-208-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number34.018574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: