Provider Demographics
NPI:1144249624
Name:OCTAVIANI, CLARYLEE (MD)
Entity type:Individual
Prefix:DR
First Name:CLARYLEE
Middle Name:
Last Name:OCTAVIANI
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 1:2180 W SR 434 STE 1164
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5008
Mailing Address - Country:US
Mailing Address - Phone:407-515-2211
Mailing Address - Fax:407-309-5412
Practice Address - Street 1:766 N SUN DR STE 3030
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2555
Practice Address - Country:US
Practice Address - Phone:407-444-2800
Practice Address - Fax:407-444-2810
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128543207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME128543OtherFLORIDA LICENSE
FLME128543OtherFLORIDA LICENSE