Healthcare Provider Details

I. General information

NPI: 1174681860
Provider Name (Legal Business Name): MICHELE G. DELANCY BS,LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 6TH AVE W
BRADENTON FL
34205-8820
US

IV. Provider business mailing address

PO BOX 1694
SARASOTA FL
34230-1694
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4100
  • Fax: 941-782-4101
Mailing address:
  • Phone: 941-782-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: