Healthcare Provider Details

I. General information

NPI: 1427064435
Provider Name (Legal Business Name): GUIDO F NODAL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MALABAR RD NE
PALM BAY FL
32907-2506
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 305-296-6668
  • Fax: 305-296-6797
Mailing address:
  • Phone: 321-434-8078
  • Fax: 321-434-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME0050170
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0050170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: