Healthcare Provider Details

I. General information

NPI: 1184560567
Provider Name (Legal Business Name): DELLA FORMA SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 PALERMO PL
VENICE FL
34285-2821
US

IV. Provider business mailing address

213 PALERMO PL
VENICE FL
34285-2821
US

V. Phone/Fax

Practice location:
  • Phone: 941-485-7783
  • Fax: 941-484-9188
Mailing address:
  • Phone: 941-485-7783
  • Fax: 941-484-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARISSA L PATETE
Title or Position: OWNER
Credential: M.D.
Phone: 941-587-7783