Provider Demographics
NPI:1710975073
Name:TRAPANI, VICENTE CONRADO (MD)
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:CONRADO
Last Name:TRAPANI
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 1:1055 N DIXIE FWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6201
Mailing Address - Country:US
Mailing Address - Phone:386-423-0505
Mailing Address - Fax:386-423-0515
Practice Address - Street 1:1055 N DIXIE FWY
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6201
Practice Address - Country:US
Practice Address - Phone:386-423-0505
Practice Address - Fax:386-423-0515
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73099174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG57177Medicare UPIN
FL41863Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER