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General NPI Number Information
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NPI Number | 1669462123
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Entity Type | Individual
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Provider Name | VITALY BLATNOY MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 7560 RED BUG LAKE RD STE 1014
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City | OVIEDO
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State | FL
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Zip | 32765-6591
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Country | US
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Telephone | 407-706-1770
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Fax | 407-706-1777
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Provider Business Mailing Address
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Address Line | 7560 RED BUG LAKE RD STE 1014
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City | OVIEDO
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State | FL
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Zip | 32765-6591
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Country | US
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Telephone | 407-706-1770
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Fax | 407-706-1777
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | ME92940
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME92940
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License Number State | FL
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