Provider Demographics
NPI:1881222800
Name:CARDILLO, TRISHA KENT (MD)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:KENT
Last Name:CARDILLO
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 1:5635 SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-8006
Mailing Address - Country:US
Mailing Address - Phone:404-644-3865
Mailing Address - Fax:
Practice Address - Street 1:5635 SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-8006
Practice Address - Country:US
Practice Address - Phone:404-644-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1668022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry