Provider Demographics
NPI:1417904616
Name:SYLORA, ROXANNE LIBI (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:LIBI
Last Name:SYLORA
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 1:400 CELEBRATION PL STE A320
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4970
Mailing Address - Country:US
Mailing Address - Phone:407-409-8000
Mailing Address - Fax:
Practice Address - Street 1:400 CELEBRATION PL STE A320
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-409-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36097370208200000X
FLME113544208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634506OtherBLUE CROSS BLUE SHIELD
IL036097370Medicaid
ILP00206868Medicare ID - Type UnspecifiedMEDICARE RAILROAD
IL209853Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
ILK09880Medicare ID - Type UnspecifiedGROUP NUMBER
IL036097370Medicaid