Provider Demographics
NPI:1558469338
Name:ABANILLA, FERNANDO MELOCOTON (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:MELOCOTON
Last Name:ABANILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 US 27 SOUTH
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825
Mailing Address - Country:US
Mailing Address - Phone:863-314-0555
Mailing Address - Fax:863-314-0806
Practice Address - Street 1:3030 US 27 S
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9761
Practice Address - Country:US
Practice Address - Phone:863-314-0555
Practice Address - Fax:863-314-0806
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066898207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93735Medicare UPIN
FL26346Medicare ID - Type Unspecified