Healthcare Provider Details

I. General information

NPI: 1487294609
Provider Name (Legal Business Name): PAULA SUE DELUCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12276 TAMIAMI TRL E
NAPLES FL
34113-7954
US

IV. Provider business mailing address

315 SAINT ANDREWS BLVD APT A1
NAPLES FL
34113-7603
US

V. Phone/Fax

Practice location:
  • Phone: 239-307-3023
  • Fax:
Mailing address:
  • Phone: 317-727-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA9335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: