Provider Demographics
NPI:1962462614
Name:MORELLO, CYRIL A (MD)
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:A
Last Name:MORELLO
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 1:266 GRANADA RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8018
Mailing Address - Country:US
Mailing Address - Phone:813-909-6399
Mailing Address - Fax:
Practice Address - Street 1:266 GRANADA RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-8018
Practice Address - Country:US
Practice Address - Phone:813-909-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-26
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77808207P00000X, 207PP0204X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL758983200Medicaid
FL46950XMedicare ID - Type Unspecified
FL46950WMedicare ID - Type Unspecified
FL758983200Medicaid
G47695Medicare UPIN
FL46950VMedicare ID - Type Unspecified