Provider Demographics
NPI:1427143619
Name:VASCONCELLOS, ELZA N (MD)
Entity type:Individual
Prefix:
First Name:ELZA
Middle Name:N
Last Name:VASCONCELLOS
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 1:1695 NW 110TH AVE STE 317
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1930
Mailing Address - Country:US
Mailing Address - Phone:305-671-3654
Mailing Address - Fax:305-459-3242
Practice Address - Street 1:1695 NW 110TH AVE STE 317
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1930
Practice Address - Country:US
Practice Address - Phone:305-671-3654
Practice Address - Fax:305-459-3242
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME774052084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070259500Medicaid
FL47151Medicare ID - Type Unspecified