Healthcare Provider Details

I. General information

NPI: 1295259406
Provider Name (Legal Business Name): BRUNO LOPES CANCADO MACHADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRUNO L C MACHADO

II. Dates (important events)

Enumeration Date: 07/29/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ADVENTHEALTH WAY STE 210
PALM COAST FL
32137-4702
US

IV. Provider business mailing address

770 W GRANADA BLVD STE 101
ORMOND BEACH FL
32174-5179
US

V. Phone/Fax

Practice location:
  • Phone: 386-302-1360
  • Fax: 386-302-1361
Mailing address:
  • Phone: 386-231-4519
  • Fax: 386-368-8927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME179096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: