Healthcare Provider Details

I. General information

NPI: 1053699884
Provider Name (Legal Business Name): CYNTHIA GNECO WILAMO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SHOAL CREEK BLVD STE 118W
AUSTIN TX
78757-1007
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 612-407-8880
  • Fax: 512-407-8681
Mailing address:
  • Phone: 800-480-5243
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR2599
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number052727
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberR2599
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: