Space Coast Internal Medicine & Geriatric LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME72416 Issued in FL

Legal business name

SPACE COAST INTERNAL MEDICINE & GERIATRIC LLC

Doing business as

Space Coast Internal Medicine

Practice address

990 Palm St
Cocoa, FL 32927-5145

Phone

(321) 639-4243

Fax

(321) 639-4266

NPI assigned

Aug 16, 2006

Last updated

Dec 8, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Romanello

Title

Coo

Phone

(352) 459-3661

Specialties & licenses 1

Addresses

Other names 2

• Space Coast Internal Medicine Doing business as
• FAIAZ M RASUL Other name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Priya Konda, FNP-C

  • Nurse Practitioner
  • Cocoa, FL
  • NPI 1689379877
  Medicare reassignment NPD
• Sasha Nabbie, APRN BC

  • Nurse Practitioner
  • Orlando, FL
  • NPI 1346913787
  Medicare reassignment NPD
• Faiaz Mahmud Rasul, M.D.

  • Internal Medicine Physician
  • Cocoa, FL
  • NPI 1942313010
  Medicare reassignment NPD
• Katie Lynn Yakubowski, NP-C

  • Nurse Practitioner
  • Palm City, FL
  • NPI 1518667088
  Medicare reassignment NPD
• Adrian Elaine Tuttle, FNP

  • Family Nurse Practitioner
  • Indian Harbour Beach, FL
  • NPI 1609503572
  NPD (past)
• Lori Ann Warren, APRN

  • Family Nurse Practitioner
  • Merritt Island, FL
  • NPI 1437416120
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765152000000",
    "number": "1649383720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "SHARPES",
            "state": "FL",
            "postal_code": "329590549",
            "telephone_number": "321-639-4243",
            "fax_number": "321-639-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 PALM ST",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329275145",
            "telephone_number": "321-639-4243",
            "fax_number": "321-639-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST INTERNAL MEDICINE & GERIATRIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A",
        "authorized_official_last_name": "ROMANELLO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "352-459-3661"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME72416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Space Coast Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAIAZ M RASUL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Soni Family Practice, PLLC
• Burton Jay Soss
• Sam Sowell, PHARM.D.
• Space Coast Center for Independent Living
• Space Coast Discount Diabetic Supplies, Inc. (Space Coast Diabetic Supplies)
• Specialized Treatment, Education and Prevention Services, Inc.
• Carmen M Spector, PT
• Daylin Spence
• Carol Spencer, LCSW
• Spirit Laboratory Services

• Internal Medicine Physician in Cocoa, FL
• Providers in Cocoa, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.