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General NPI Number Information
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NPI Number | 1649383720
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Entity Type | Organization
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Legal Business Name | SPACE COAST INTERNAL MEDICINE & GERIATRIC LLC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 990 PALM ST
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City | COCOA
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State | FL
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Zip | 32927-5145
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Country | US
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Telephone | 321-639-4243
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Fax | 321-639-4266
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | SHARPES
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State | FL
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Zip | 32959-0549
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Country | US
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Telephone | 321-639-4243
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Fax | 321-639-4266
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Authorized Official
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Title or Position | COO
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Name | DAVID ROMANELLO
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Credential |
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Telephone | 352-459-3661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME72416
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License Number State | FL
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