Healthcare Provider Details

I. General information

NPI: 1770918781
Provider Name (Legal Business Name): ANDRE MELO NUNES FIALHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 WINTER GARDEN VINELAND RD STE 201
WINDERMERE FL
34786-6098
US

IV. Provider business mailing address

5151 WINTER GARDEN VINELAND RD STE 201
WINDERMERE FL
34786-6098
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-4344
  • Fax: 321-842-9360
Mailing address:
  • Phone: 321-841-4344
  • Fax: 321-842-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26036
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME157176
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number26036
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: