MEDICARE: MS. CINDY M NAZARIO- MATOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2010006918	MO
2	208000000X	Pediatrics Physician	ACN949	FL
3	208000000X	Pediatrics Physician	13467	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306882642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINDY M NAZARIO- MATOS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1137
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32902-1137
Country	:	US
Telephone Number	:	321-952-9696
Fax Number	:	321-952-7937

Provider Business Practice Location Address
First Line	:	500 N WASHINGTON AVE STE 105
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2759
Country	:	US
Telephone Number	:	321-268-0267
Fax Number	:	321-268-3357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	03/17/2018

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