1982110276 NPI number — ANGELICA SHARYS ROMAN RIVERA MD

Table of content: ANGELICA SHARYS ROMAN RIVERA MD (NPI 1982110276)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982110276 NPI number — ANGELICA SHARYS ROMAN RIVERA MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
ROMAN RIVERA

Provider First Name:
ANGELICA

Provider Middle Name:
SHARYS

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
MD

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982110276

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
11/21/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S HARBOUR ISLAND BLVD STE 200

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
TAMPA

Provider Business Mailing Address State Name:
FL

Provider Business Mailing Address Postal Code:
33602-5925

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
800-480-5243

Provider Business Mailing Address Fax Number:
800-928-7449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 NE 25TH AVE STE 301

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
OCALA

Provider Business Practice Location Address State Name:
FL

Provider Business Practice Location Address Postal Code:
34470-5667

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
352-351-7000

Provider Business Practice Location Address Fax Number:
352-236-8610

Provider Enumeration Date:
12/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 208D00000X , with the licence number: 19822 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 208D00000X , with the licence number: ACN1437 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .