Healthcare Provider Details

I. General information

NPI: 1861535726
Provider Name (Legal Business Name): LINDA DELO DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34984-5150
US

IV. Provider business mailing address

514 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34984-5150
US

V. Phone/Fax

Practice location:
  • Phone: 772-871-5900
  • Fax: 772-871-1197
Mailing address:
  • Phone: 772-871-5900
  • Fax: 772-871-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberOS05326
License Number StateFL

VIII. Authorized Official

Name: DR. LINDA FAY DELO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 772-871-5900