Provider Demographics
NPI:1699465823
Name:MUFALO, CECILIA M (RN)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:M
Last Name:MUFALO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 CYPRESS GLADES LN FL 32824
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-7395
Mailing Address - Country:US
Mailing Address - Phone:407-493-1606
Mailing Address - Fax:321-352-7275
Practice Address - Street 1:4013 CYPRESS GLADES LN FL 32824
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-7395
Practice Address - Country:US
Practice Address - Phone:407-493-1606
Practice Address - Fax:321-352-7275
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9441468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse