Provider Demographics
NPI:1487687943
Name:RIOBE HERON, MYLAINE (MD)
Entity type:Individual
Prefix:DR
First Name:MYLAINE
Middle Name:
Last Name:RIOBE HERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYLAINE
Other - Middle Name:
Other - Last Name:RIOBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1001 SE MONTEREY COMMONS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3329
Mailing Address - Country:US
Mailing Address - Phone:772-266-4258
Mailing Address - Fax:772-219-8111
Practice Address - Street 1:345 7TH AVENUE
Practice Address - Street 2:#1601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:917-477-3538
Practice Address - Fax:772-219-8111
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82630207V00000X, 202D00000X
NY322475207V00000X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH45592Medicare UPIN