Provider Demographics
NPI:1508257932
Name:FIALLO, NOEL (BS)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:
Last Name:FIALLO
Suffix:
Gender:
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 NW 151ST ST STE 127
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2442
Mailing Address - Country:US
Mailing Address - Phone:786-905-2262
Mailing Address - Fax:786-398-5500
Practice Address - Street 1:5881 NW 151ST ST STE 127
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2442
Practice Address - Country:US
Practice Address - Phone:786-905-2262
Practice Address - Fax:786-389-5500
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116153500Medicaid