Provider Demographics
NPI:1104669357
Name:FERREIRA LOPES FONTANELLI, RAQUEL CAROLINE (PHD, BC-HIS)
Entity type:Individual
Prefix:
First Name:RAQUEL CAROLINE
Middle Name:
Last Name:FERREIRA LOPES FONTANELLI
Suffix:
Gender:F
Credentials:PHD, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10375 VISTA OAKS CT UNIT 409
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-4672
Mailing Address - Country:US
Mailing Address - Phone:689-253-4807
Mailing Address - Fax:
Practice Address - Street 1:510 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3601
Practice Address - Country:US
Practice Address - Phone:863-293-6507
Practice Address - Fax:863-291-0737
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5808332S00000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332S00000XSuppliersHearing Aid Equipment