Provider Demographics
NPI:1336448794
Name:ELVAMBUENA, GLIVERY MARY GAYAHAN (MD)
Entity type:Individual
Prefix:
First Name:GLIVERY MARY
Middle Name:GAYAHAN
Last Name:ELVAMBUENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLIVERY MARY
Other - Middle Name:GENIL
Other - Last Name:GAYAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14100 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-9900
Mailing Address - Country:US
Mailing Address - Phone:407-489-3862
Mailing Address - Fax:
Practice Address - Street 1:14100 58TH ST N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-9900
Practice Address - Country:US
Practice Address - Phone:727-824-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 119632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics