Provider Demographics
NPI:1326067281
Name:DELELLIS, SALVATORE LEONARD (DPM)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:LEONARD
Last Name:DELELLIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 SOUTH PINELLAS AVENUE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689
Mailing Address - Country:US
Mailing Address - Phone:727-937-6398
Mailing Address - Fax:727-937-6568
Practice Address - Street 1:1264 SOUTH PINELLAS AVENUE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689
Practice Address - Country:US
Practice Address - Phone:727-937-6398
Practice Address - Fax:727-937-6568
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01223213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041300300Medicaid
FL87660OtherBCBS
FL406480477OtherRAILROAD MEDICARE
FL406480477OtherRAILROAD MEDICARE
FL87660Medicare PIN