Healthcare Provider Details

I. General information

NPI: 1285188219
Provider Name (Legal Business Name): STEFANIE MARIE INDELLICATI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 VILLAGE BLVD STE 201
WEST PALM BEACH FL
33409-1972
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-6664
  • Fax: 561-964-8599
Mailing address:
  • Phone: 561-964-6664
  • Fax: 561-964-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: