Provider Demographics
NPI:1164050001
Name:COLLADO FUENTES, RUSDANY (MD)
Entity type:Individual
Prefix:DR
First Name:RUSDANY
Middle Name:
Last Name:COLLADO FUENTES
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 1:13783 SW 66TH ST APT A219
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2200
Mailing Address - Country:US
Mailing Address - Phone:305-502-3553
Mailing Address - Fax:
Practice Address - Street 1:10621 N KENDALL DR STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1530
Practice Address - Country:US
Practice Address - Phone:786-334-2494
Practice Address - Fax:786-221-2883
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME159106207Q00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine