Healthcare Provider Details

I. General information

NPI: 1255422598
Provider Name (Legal Business Name): MARDELLE DELIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 SE 8TH TER
CAPE CORAL FL
33990-3212
US

IV. Provider business mailing address

12730 NEW BRITTANY BLVD STE 602
FORT MYERS FL
33907-4690
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-1988
  • Fax: 239-574-7765
Mailing address:
  • Phone: 239-275-5522
  • Fax: 239-275-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23848
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberME103322
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME103322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: