Provider Demographics
NPI:1548423551
Name:ELGAWLEY, NYHALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NYHALE
Middle Name:
Last Name:ELGAWLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13418 ZORI LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7355
Mailing Address - Country:US
Mailing Address - Phone:407-406-3638
Mailing Address - Fax:407-483-9991
Practice Address - Street 1:3268 GREENWALD WAY N
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0728
Practice Address - Country:US
Practice Address - Phone:407-483-9990
Practice Address - Fax:407-483-9991
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 188481223G0001X
TX24105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist