Healthcare Provider Details

I. General information

NPI: 1861021651
Provider Name (Legal Business Name): VINCENT RICCELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S FEDERAL HWY STE 110
BOCA RATON FL
33432-4938
US

IV. Provider business mailing address

233 S FEDERAL HWY STE 110
BOCA RATON FL
33432-4938
US

V. Phone/Fax

Practice location:
  • Phone: 561-266-4344
  • Fax: 850-588-4077
Mailing address:
  • Phone: 561-266-4344
  • Fax: 850-588-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME178822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: