Provider Demographics
NPI:1154540425
Name:SILVER LAKE PEDIATRICS, PA
Entity type:Organization
Organization Name:SILVER LAKE PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHEAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-314-2275
Mailing Address - Street 1:33017 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3750
Mailing Address - Country:US
Mailing Address - Phone:352-314-2275
Mailing Address - Fax:352-314-2279
Practice Address - Street 1:33017 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3750
Practice Address - Country:US
Practice Address - Phone:352-314-2275
Practice Address - Fax:352-314-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty