Provider Demographics
NPI:1548733280
Name:PERLADO, JESSIE AMEDO
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:AMEDO
Last Name:PERLADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 LAKE HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2689
Mailing Address - Country:US
Mailing Address - Phone:863-393-7222
Mailing Address - Fax:863-583-0878
Practice Address - Street 1:454 LAKE HARRIS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2689
Practice Address - Country:US
Practice Address - Phone:863-393-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor