MEDICARE: DE LISA BONAPARTE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1811239171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DE LISA BONAPARTE

Provider Business Mailing Address
First Line	:	2295 S HIAWASSEE RD STE 104
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8748
Country	:	US
Telephone Number	:	904-566-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	2295 S HIAWASSEE RD STE 104
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8748
Country	:	US
Telephone Number	:	904-566-1975
Fax Number	:

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

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	06/09/2026

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Directions to “ DE LISA BONAPARTE ” Practice Location

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