Provider Demographics
NPI:1225033848
Name:DELO, LINDA FAY (DO PA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:FAY
Last Name:DELO
Suffix:
Gender:F
Credentials:DO PA
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:FAY
Other - Last Name:DELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:514 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5108
Mailing Address - Country:US
Mailing Address - Phone:772-871-5900
Mailing Address - Fax:772-871-1197
Practice Address - Street 1:514 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5108
Practice Address - Country:US
Practice Address - Phone:772-871-5900
Practice Address - Fax:772-871-1197
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0112160OtherGHI
FL82976OtherBCBS
FL0112160OtherGHI
FLE32323Medicare UPIN
FLK3250Medicare PIN