Provider Demographics
NPI:1063435592
Name:COLLAZO, SYLVIA (MD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 ACADEMY CIR E APT 107
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8510
Mailing Address - Country:US
Mailing Address - Phone:787-648-6653
Mailing Address - Fax:407-910-4740
Practice Address - Street 1:833 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5838
Practice Address - Country:US
Practice Address - Phone:407-350-3373
Practice Address - Fax:407-910-4740
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN456208D00000X
PR14205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021105Medicare PIN
PRH70730Medicare UPIN