Provider Demographics
NPI:1205804259
Name:COLON TIRADO, AMARILYS (MD)
Entity type:Individual
Prefix:DR
First Name:AMARILYS
Middle Name:
Last Name:COLON TIRADO
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:PO BOX 470159
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-0159
Mailing Address - Country:US
Mailing Address - Phone:787-462-3807
Mailing Address - Fax:
Practice Address - Street 1:5979 VINELAND RD STE 209
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7855
Practice Address - Country:US
Practice Address - Phone:407-250-5030
Practice Address - Fax:407-250-5043
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14341208D00000X
FLACN867208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14341OtherPR LICENSE
FLACN867OtherFL MEDICAL LICENSE
FLBC7941758OtherDEA