Healthcare Provider Details

I. General information

NPI: 1669751855
Provider Name (Legal Business Name): TINA FABIANO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S CONGRESS AVE STE 420
BOYNTON BEACH FL
33426-6588
US

IV. Provider business mailing address

3050 SAINT JAMES DR
BOCA RATON FL
33434-3369
US

V. Phone/Fax

Practice location:
  • Phone: 561-364-1479
  • Fax:
Mailing address:
  • Phone: 847-308-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.134175
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberOS14846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: