Healthcare Provider Details

I. General information

NPI: 1003896507
Provider Name (Legal Business Name): JANE EVELYN MATOS-FRAEBEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW 84TH AVENUE SUITE 203
PLANTATION FL
33324-2754
US

IV. Provider business mailing address

220 SW 84TH AVE SUITE 203
PLANTATION FL
33324-2754
US

V. Phone/Fax

Practice location:
  • Phone: 954-998-7760
  • Fax: 954-998-7761
Mailing address:
  • Phone: 954-998-7760
  • Fax: 954-998-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME89082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: