Provider Demographics
NPI:1174769954
Name:ROSADO LARROY, DELVY (MD)
Entity type:Individual
Prefix:DR
First Name:DELVY
Middle Name:
Last Name:ROSADO LARROY
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 1:16119 FLORETS DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-4020
Mailing Address - Country:US
Mailing Address - Phone:606-571-0787
Mailing Address - Fax:
Practice Address - Street 1:5201 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8741
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3765
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17452208D00000X, 261QP2300X
FLACN1292208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108297400Medicaid