Provider Demographics
NPI:1669541678
Name:DE OLIVEIRA, FERNANDA POLEY (MD)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:POLEY
Last Name:DE OLIVEIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 18TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6481
Mailing Address - Country:US
Mailing Address - Phone:729-258-2007
Mailing Address - Fax:772-925-8199
Practice Address - Street 1:1255 37TH ST STE C
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6550
Practice Address - Country:US
Practice Address - Phone:772-494-1770
Practice Address - Fax:772-494-1774
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG18721Medicare UPIN