MEDICARE: DR. ALFRED DEAN VONETES PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	8364348	FL
2	103TC2200X	Clinical Child & Adolescent Psychologist	PY 8996	FL
3	103TC0700X	Clinical Psychologist	PY 8996	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PY8996	OTHER	FL	FL STATE PROFESSIONAL LICENSE
2	8364348	OTHER	FL	FLORIDA STATE LICENSE

General Provider Information

NPI Number	:	1326452897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED DEAN VONETES PSY.D

Provider Business Mailing Address
First Line	:	4700 MILLENIA BLVD STE 175
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6015
Country	:	US
Telephone Number	:	804-920-5613
Fax Number	:	866-480-9482

Provider Business Practice Location Address
First Line	:	4700 MILLENIA BLVD STE 175
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6015
Country	:	US
Telephone Number	:	407-494-7880
Fax Number	:	866-480-9482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	02/08/2019

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