MEDICARE: RAQUEL CAROLINE FERREIRA LOPES FONTANELLI PHD, BC-HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment	AS5808	FL
2	237700000X	Hearing Instrument Specialist	AS5808	FL

General Provider Information

NPI Number	:	1104669357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL CAROLINE FERREIRA LOPES FONTANELLI PHD, BC-HIS

Provider Business Mailing Address
First Line	:	10375 VISTA OAKS CT UNIT 409
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-4672
Country	:	US
Telephone Number	:	689-253-4807
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 1ST ST S
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3601
Country	:	US
Telephone Number	:	863-293-6507
Fax Number	:	863-291-0737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/26/2025

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