MEDICARE: ANGELICA SHARYS ROMAN RIVERA 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	208D00000X	General Practice Physician	19822	PR
2	208D00000X	General Practice Physician	ACN1437	FL

General Provider Information

NPI Number	:	1982110276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA SHARYS ROMAN RIVERA MD

Provider Business Mailing Address
First Line	:	601 S HARBOUR ISLAND BLVD STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5925
Country	:	US
Telephone Number	:	800-480-5243
Fax Number	:	800-928-7449

Provider Business Practice Location Address
First Line	:	1111 NE 25TH AVE STE 301
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-5667
Country	:	US
Telephone Number	:	352-351-7000
Fax Number	:	352-236-8610

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	11/21/2022

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