MEDICARE: DR. CHRISTOPHER ADALIO PH.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	10934	FL
2	103T00000X	Psychologist	PY10934	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679179667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER ADALIO PH.D.

Provider Business Mailing Address
First Line	:	6271 SAINT AUGUSTINE RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6271 SAINT AUGUSTINE RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2555
Country	:	US
Telephone Number	:	904-633-0750
Fax Number	:

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

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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