MEDICARE: VINICIUS ADAMI VAYEGO FORNAZARI MD

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	2085R0202X	Diagnostic Radiology Physician	1001	FL
2	2085R0204X	Vascular & Interventional Radiology Physician	1001	FL

General Provider Information

NPI Number	:	1790634343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINICIUS ADAMI VAYEGO FORNAZARI MD

Provider Business Mailing Address
First Line	:	655 W 8TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-4202
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 W 8TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-4202
Fax Number	:

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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