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General NPI Number Information
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NPI Number | 1861535726
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Entity Type | Organization
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Legal Business Name | LINDA DELO DO PA
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 514 SE PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5150
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Country | US
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Telephone | 772-871-5900
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Fax | 772-871-1197
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Provider Business Mailing Address
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Address Line | 514 SE PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5150
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Country | US
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Telephone | 772-871-5900
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Fax | 772-871-1197
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LINDA FAY DELO
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Credential | D.O.
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Telephone | 772-871-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OS05326
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License Number State | FL
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