Healthcare Provider Details

I. General information

NPI: 1417885682
Provider Name (Legal Business Name): PATRICIA ANNA DEVITO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 OCEAN AVE
MELBOURNE BEACH FL
32951-2524
US

IV. Provider business mailing address

1708 ATLANTIC ST APT 4E
MELBOURNE BEACH FL
32951-2343
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-6565
  • Fax:
Mailing address:
  • Phone: 321-693-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH10738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: