Healthcare Provider Details

I. General information

NPI: 1023958071
Provider Name (Legal Business Name): LIONEL DELGADO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 55TH AVENUE CIR E APT 105
BRADENTON FL
34203-4475
US

IV. Provider business mailing address

1635 55TH AVENUE CIR E APT 105
BRADENTON FL
34203-4475
US

V. Phone/Fax

Practice location:
  • Phone: 941-226-9948
  • Fax:
Mailing address:
  • Phone: 941-226-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH-35218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: