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General NPI Number Information
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NPI Number | 1720047954
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Entity Type | Individual
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Provider Name | JAMIE MICHELLE DEMAIO M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 1417 LAKELAND HILLS BLVD STE 204
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City | LAKELAND
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State | FL
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Zip | 33805-3208
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Country | US
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Telephone | 863-688-5811
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 LAKELAND HILLS BLVD STE 204
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City | LAKELAND
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State | FL
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Zip | 33805-3208
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Country | US
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Telephone | 863-688-5811
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Fax | 863-688-5866
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 10638
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License Number State | PR
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