Healthcare Provider Details

I. General information

NPI: 1528021557
Provider Name (Legal Business Name): EDGARDO FELICIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6239 LAKE WORTH RD
GREENACRES FL
33463-3003
US

IV. Provider business mailing address

6239 LAKE WORTH RD
GREENACRES FL
33463-3003
US

V. Phone/Fax

Practice location:
  • Phone: 561-812-1271
  • Fax: 561-964-4050
Mailing address:
  • Phone: 561-812-1271
  • Fax: 561-964-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME138722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: