Provider Demographics
NPI:1376928994
Name:DEBELLO, ANTONELLA
Entity Type:Individual
Prefix:
First Name:ANTONELLA
Middle Name:
Last Name:DEBELLO
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 1:17759 LITTEN DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6437
Mailing Address - Country:US
Mailing Address - Phone:914-714-0669
Mailing Address - Fax:718-795-4389
Practice Address - Street 1:3201 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1N
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1247
Practice Address - Country:US
Practice Address - Phone:914-714-0669
Practice Address - Fax:718-795-4389
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC52124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist