Provider Demographics
NPI:1396845459
Name:DELGADO, MARIANA (MD)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 2ND ST N
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3516
Mailing Address - Country:US
Mailing Address - Phone:727-799-7530
Mailing Address - Fax:727-799-7530
Practice Address - Street 1:802 2ND ST N
Practice Address - Street 2:SUITE B-1
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3516
Practice Address - Country:US
Practice Address - Phone:727-799-7530
Practice Address - Fax:727-799-7530
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME912712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD-086Medicare PIN