Provider Demographics
NPI:1174260129
Name:VENDITTI, BELLISIMA DIAROSA
Entity Type:Individual
Prefix:
First Name:BELLISIMA
Middle Name:DIAROSA
Last Name:VENDITTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52441 ROBINS NEST DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1225 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1905
Practice Address - Country:US
Practice Address - Phone:248-524-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-10-05
Deactivation Date:2022-08-17
Deactivation Code:
Reactivation Date:2022-10-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator