Healthcare Provider Details

I. General information

NPI: 1912171851
Provider Name (Legal Business Name): ELLEN M DELANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 SEMINOLE BLVD
LARGO FL
33770-8106
US

IV. Provider business mailing address

1590 SEMINOLE BLVD
LARGO FL
33770-8106
US

V. Phone/Fax

Practice location:
  • Phone: 727-518-2268
  • Fax:
Mailing address:
  • Phone: 727-518-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA14331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: