Provider Demographics
NPI:1487654166
Name:SORRENTO, DEAN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:L
Last Name:SORRENTO
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 1:15815 SHADDOCK DR STE 130
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5773
Mailing Address - Country:US
Mailing Address - Phone:813-400-1140
Mailing Address - Fax:813-870-3569
Practice Address - Street 1:5841 ARGERIAN DR STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-4505
Practice Address - Country:US
Practice Address - Phone:813-788-1006
Practice Address - Fax:813-726-5153
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4427213EP1101X, 213E00000X, 213ES0000X, 213ES0131X, 213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW869667OtherBLUE SHIELD
FL115123700Medicaid
PA0018011310003Medicaid
PA01229701OtherBLUE CROSS
FLOKZQ5OtherBCBS
PA036276Medicare PIN