Provider Demographics
NPI:1750012779
Name:CARVALHO, PRISCYLLA
Entity type:Individual
Prefix:MISS
First Name:PRISCYLLA
Middle Name:
Last Name:CARVALHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 3RD ST NW APT 1326
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5987
Mailing Address - Country:US
Mailing Address - Phone:407-591-1076
Mailing Address - Fax:
Practice Address - Street 1:12139 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6802
Practice Address - Country:US
Practice Address - Phone:407-535-1313
Practice Address - Fax:407-778-1479
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118283363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical