Provider Demographics
NPI:1518957984
Name:SIINO, MICHAEL T (PAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:SIINO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 VILLAGE SQUARE XING
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4543
Mailing Address - Country:US
Mailing Address - Phone:561-693-0540
Mailing Address - Fax:561-296-6174
Practice Address - Street 1:7605 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2646
Practice Address - Country:US
Practice Address - Phone:321-732-8150
Practice Address - Fax:407-613-5915
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3235363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S59678Medicare UPIN
E1011YMedicare ID - Type Unspecified
FL008164100Medicaid