Healthcare Provider Details

I. General information

NPI: 1700072725
Provider Name (Legal Business Name): DELIA VONA RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E NEW HAVEN AVE
MELBOURNE FL
32901-5474
US

IV. Provider business mailing address

930 S HARBOR CITY BLVD
MELBOURNE FL
32901-1963
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-4545
  • Fax: 321-728-4168
Mailing address:
  • Phone: 321-725-5050
  • Fax: 321-725-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: