Healthcare Provider Details

I. General information

NPI: 1699930198
Provider Name (Legal Business Name): RYAN DE MELO RABELO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

PO BOX 7623
NAPLES FL
34101-7623
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-4400
  • Fax: 305-285-5068
Mailing address:
  • Phone: 305-712-7229
  • Fax: 305-397-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME128335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: