Healthcare Provider Details

I. General information

NPI: 1346223658
Provider Name (Legal Business Name): DR. ANTONIO FORTUNATO DE FILIPPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANTONIO DE FILIPPO MD

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 HOLLYWOOD BLVD STE 2
HOLLYWOOD FL
33020-6605
US

IV. Provider business mailing address

2421 HOLLYWOOD BLVD STE 2
HOLLYWOOD FL
33020-6605
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-6200
  • Fax: 954-962-5495
Mailing address:
  • Phone: 954-962-6200
  • Fax: 954-962-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number650738801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: