Provider Demographics
NPI:1326279167
Name:DELVA, KEISHA TRACEY
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:TRACEY
Last Name:DELVA
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 1:1485 S. SEMORAN BLVD., WINTER PARK, FL 32792
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5533
Mailing Address - Country:US
Mailing Address - Phone:321-397-3000
Mailing Address - Fax:407-681-5478
Practice Address - Street 1:1485 S. SEMORAN BLVD., WINTER PARK, FL 32792
Practice Address - Street 2:SUITE 1402
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5533
Practice Address - Country:US
Practice Address - Phone:321-397-3000
Practice Address - Fax:407-681-5478
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor