Healthcare Provider Details

I. General information

NPI: 1932589199
Provider Name (Legal Business Name): FRANK GUDICELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SPRAY RD
KEY LARGO FL
33037-3724
US

IV. Provider business mailing address

9 SPRAY RD
KEY LARGO FL
33037-3724
US

V. Phone/Fax

Practice location:
  • Phone: 305-394-8208
  • Fax:
Mailing address:
  • Phone: 305-394-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME124104
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA03128800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: