Provider Demographics
NPI:1477962181
Name:FATNASSI, KEILA MABEL (MA)
Entity Type:Individual
Prefix:
First Name:KEILA
Middle Name:MABEL
Last Name:FATNASSI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S HARBOUR ISLAND BLVD
Mailing Address - Street 2:UNIT # 313
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5712
Mailing Address - Country:US
Mailing Address - Phone:813-846-7904
Mailing Address - Fax:
Practice Address - Street 1:510 VONDERBURG DR
Practice Address - Street 2:# 301
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5954
Practice Address - Country:US
Practice Address - Phone:813-881-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)