Provider Demographics
NPI:1780696310
Name:FELICIANO, GAYLE D (MD)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:D
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14103 PIPEVINE CT
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5472
Mailing Address - Country:US
Mailing Address - Phone:407-925-6998
Mailing Address - Fax:
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:954-399-4642
Practice Address - Fax:877-859-8768
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83446207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2700954600Medicaid
FLI19533Medicare UPIN
FLU3679ZMedicare UPIN