Provider Demographics
NPI:1508079484
Name:KILAYKO SICANGCO, MARIA VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:
Last Name:KILAYKO SICANGCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA VICTORIA
Other - Middle Name:KILAYKO
Other - Last Name:SICANGCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2950 MONTILLA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-5526
Mailing Address - Country:US
Mailing Address - Phone:904-998-8282
Mailing Address - Fax:
Practice Address - Street 1:1301 PLANTATION ISLAND DR S
Practice Address - Street 2:105B
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3108
Practice Address - Country:US
Practice Address - Phone:904-461-8906
Practice Address - Fax:904-461-8907
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71360208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278377100Medicaid