Provider Demographics
NPI:1194614438
Name:SIEGEL, MYLIE ROSEMARY (MS)
Entity type:Individual
Prefix:
First Name:MYLIE
Middle Name:ROSEMARY
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 WELLINGTON PARK CIR APT D15
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-4593
Mailing Address - Country:US
Mailing Address - Phone:484-635-4445
Mailing Address - Fax:321-843-6025
Practice Address - Street 1:44 STURTEVANT ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2012
Practice Address - Country:US
Practice Address - Phone:321-841-4363
Practice Address - Fax:321-843-6025
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS