Provider Demographics
NPI:1699930198
Name:DE MELO RABELO, RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:DE MELO RABELO
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:PO BOX 7623
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-7623
Mailing Address - Country:US
Mailing Address - Phone:305-712-7229
Mailing Address - Fax:305-397-1139
Practice Address - Street 1:3663 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4253
Practice Address - Country:US
Practice Address - Phone:305-854-4400
Practice Address - Fax:305-285-5068
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1283352085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14264316OtherCAQH
FLIQ581ZOtherFLORIDA MEDICARE
FLP01708544OtherFLORIDA RAILROAD MEDICARE
FL113565200Medicaid
FL77RO1OtherFLORIDA BLUE (BCBS)