Healthcare Provider Details

I. General information

NPI: 1720466634
Provider Name (Legal Business Name): WHITNEY VEDELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15420 COLLIER BLVD
NAPLES FL
34120-3917
US

IV. Provider business mailing address

PO BOX 1357
FORT MYERS FL
33902-1357
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0570
  • Fax: 239-643-8855
Mailing address:
  • Phone: 239-278-3600
  • Fax: 239-226-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME136169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: