Provider Demographics
NPI:1194713370
Name:VIGGIANO, DONATO ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:DONATO
Middle Name:ANTHONY
Last Name:VIGGIANO
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 1:1901 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5582
Mailing Address - Country:US
Mailing Address - Phone:772-335-7477
Mailing Address - Fax:772-335-8379
Practice Address - Street 1:1901 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5582
Practice Address - Country:US
Practice Address - Phone:772-335-3954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43082OtherBCBS OF FLORIDA
FL650799434OtherCHAMPUS
FL067096100Medicaid
FL240007672OtherRAILROAD MEDICARE
FL067096100Medicaid
FL7-43082Medicare ID - Type Unspecified