Provider Demographics
NPI:1518276104
Name:CAPALLIA, PAMELA (BSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CAPALLIA
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-1195
Mailing Address - Country:US
Mailing Address - Phone:813-943-1097
Mailing Address - Fax:813-780-9740
Practice Address - Street 1:38241 13TH AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3629
Practice Address - Country:US
Practice Address - Phone:813-943-5715
Practice Address - Fax:813-780-9740
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688716396Medicaid
FL688716398Medicaid