Healthcare Provider Details

I. General information

NPI: 1699778274
Provider Name (Legal Business Name): JULIE MELENE DEKLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 BLOOMINGDALE AVE STE 223
VALRICO FL
33596-6403
US

IV. Provider business mailing address

2470 BLOOMINGDALE AVE STE 223
VALRICO FL
33596-6403
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-7139
  • Fax: 813-443-8157
Mailing address:
  • Phone: 813-689-7139
  • Fax: 813-443-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME77884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: