Individual
DR. SALLY SAMIR ELIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11715 ORPINGTON STREET, SUITE A, TLC PEDIATRICS AND ADOLESCENT MEDICINE IN ASSOC WITH NE, ORLANDO, FL 32817-4600
(407) 380-9115
(407) 380-9189
Mailing address
P.O. BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-4488
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME92584
FL
208000000X
Pediatrics Physician
ME92588
FL
208D00000X
General Practice Physician
Primary
ME92584
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004130500
—
FL
01
—
18160
FHHS
FL
01
—
2540464
UNITED HEALTHCARE
FL
01
—
28634
BCBS
FL
05
—
28634Z
—
FL
01
—
7428721
AETNA HEALTHCARE
FL
01
—
8894941
CIGNA HEALTHCARE
FL
Enumeration date
07/08/2006
Last updated
11/09/2012
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